Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 0615105 | OH |
NPI | 1285609370 |
---|---|
Provider Name | Pani Saranga Akuthota |
First Address | Dayton, OH 45406-1891 |
Second Address | Dayton, OH 45406-1891 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 20/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0615105 | (05) | OH |
250006022 | MEDICARE ID (01) | OH |
A16332 | (02) | OH |