Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 35.139893 | OH |
Y | 207YP0228X | Pediatric Otolaryngology | 35.139893 | OH |
NPI | 1386061679 |
---|---|
Provider Name | Dr. Prasanth Pattisapu |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43205-2664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2014 |
Last Update Date | 22/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0407117 | (05) | OH |
H766830 | CGS - MEDICARE (01) | OH |