Individual
MR. VETTAIKORUMAKANKAV V VEDANARAYANAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 BAPTIST DR STE 301, MADISON, MS 39110-2012
(601) 984-5210
(601) 499-0936
Mailing address
7731 OLD CANTON RD STE B, MADISON, MS 39110-6115
(601) 499-0935
(601) 499-0936
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
12953
MS
208000000X
Pediatrics Physician
12953
MS
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
12953
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00019355
—
MS
05
—
155977
—
AL
05
—
1982156
—
LA
01
—
P01234014
RAILROAD MEDICARE PTAN
MS
01
—
PTAN P00462340
RR MEDICARE
MS
Enumeration date
06/12/2006
Last updated
05/23/2019
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