Provider Demographics
NPI:1043201700
Name:PINNAMANENI, V CHOWDRY (MD)
Entity Type:Individual
Prefix:
First Name:V
Middle Name:CHOWDRY
Last Name:PINNAMANENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-2860
Mailing Address - Country:US
Mailing Address - Phone:203-568-0531
Mailing Address - Fax:888-400-1839
Practice Address - Street 1:204 NE 15TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2104
Practice Address - Country:US
Practice Address - Phone:317-333-9960
Practice Address - Fax:888-400-1839
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056444A2083P0011X
IN01056444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200810500Medicaid
IN200810500Medicaid