Provider Demographics
NPI:1528273141
Name:VENKATESAN, CHARULATA (MD PHD)
Entity type:Individual
Prefix:DR
First Name:CHARULATA
Middle Name:
Last Name:VENKATESAN
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML 2015
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4222
Mailing Address - Fax:513-636-1888
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 2015
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4222
Practice Address - Fax:513-636-1888
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1237682084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology