Individual
DR. VENKATA SUSRUT PENDYALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 GOETHALS DR STE F, RICHLAND, WA 99352-3301
(509) 942-3272
(509) 942-3273
Mailing address
550 GAGE BLVD STE 101, RICHLAND, WA 99352-9532
(509) 942-3627
(509) 627-2983
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-138524
IL
207R00000X
Internal Medicine Physician
MD61171799
WA
207RC0000X
Cardiovascular Disease Physician
MD61171799
WA
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
MD61171799
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036138524
—
IL
Enumeration date
07/18/2012
Last updated
09/20/2021
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