Provider Demographics
NPI:1043469471
Name:PENUMETSA, MARUTHI SRIKANTH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARUTHI
Middle Name:SRIKANTH
Last Name:PENUMETSA
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 1:4015 GATEWAY BLVD
Mailing Address - Street 2:STE 2120
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9460
Mailing Address - Country:US
Mailing Address - Phone:812-492-5457
Mailing Address - Fax:812-464-4485
Practice Address - Street 1:4007 GATEWAY BLVD # 100
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8947
Practice Address - Country:US
Practice Address - Phone:812-842-0907
Practice Address - Fax:812-490-7919
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA249875207R00000X, 208M00000X
PAMD452272207RC0000X
IN01078151A207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist