Individual
VIVEKANANDA VARMA DATLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.,
Contact information
Practice address
2201 LEXINGTON AVE, ASHLAND, KY 41101-2843
(606) 408-4000
(606) 408-6825
Mailing address
PO BOX 2379, ASHLAND, KY 41105-2379
(606) 408-6200
(606) 408-6612
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
43412
KY
208M00000X
Hospitalist Physician
Primary
43412
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3066524
—
OH
05
—
7100129360
—
KY
Enumeration date
06/07/2007
Last updated
05/18/2022
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