Provider Demographics
NPI:1346386224
Name:PENUMACHA, VANAJA (MD)
Entity Type:Individual
Prefix:DR
First Name:VANAJA
Middle Name:
Last Name:PENUMACHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VANAJA
Other - Middle Name:
Other - Last Name:DOMMARAJU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12884 TOWN AND 4 DR
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6257
Mailing Address - Country:US
Mailing Address - Phone:314-439-9110
Mailing Address - Fax:
Practice Address - Street 1:232 S WOODS MILL RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3417
Practice Address - Country:US
Practice Address - Phone:314-434-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006036877207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine