Provider Demographics
NPI:1770135550
Name:RAYASAM, VENUMADHAV (MD)
Entity type:Individual
Prefix:
First Name:VENUMADHAV
Middle Name:
Last Name:RAYASAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4168
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4168
Mailing Address - Country:US
Mailing Address - Phone:208-239-1035
Mailing Address - Fax:208-239-3626
Practice Address - Street 1:777 HOSPITAL WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5175
Practice Address - Country:US
Practice Address - Phone:208-239-2640
Practice Address - Fax:208-239-3737
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID1561378207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine