Provider Demographics
NPI:1326232984
Name:PANNU, RAJMONY (MD)
Entity Type:Individual
Prefix:MR
First Name:RAJMONY
Middle Name:
Last Name:PANNU
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 1:450 ALKYRE RUN STE 350
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-6912
Mailing Address - Country:US
Mailing Address - Phone:614-293-2594
Mailing Address - Fax:
Practice Address - Street 1:2600 6TH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:614-917-0696
Practice Address - Fax:888-732-7890
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC142049207R00000X
MN104482207RC0000X
MN52323207RC0000X
OH35.121853207RI0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
MNENROLLEDMedicaid
IAENROLLEDMedicaid
OHPENDINGMedicare PIN
MN060003024Medicare PIN