Provider Demographics
NPI:1346400058
Name:AMIRNENI, VAMSEE K (MD)
Entity Type:Individual
Prefix:
First Name:VAMSEE
Middle Name:K
Last Name:AMIRNENI
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 1:335 GLESSNER AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2269
Mailing Address - Country:US
Mailing Address - Phone:419-520-2495
Mailing Address - Fax:419-520-2565
Practice Address - Street 1:1750 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1770
Practice Address - Country:US
Practice Address - Phone:419-520-3530
Practice Address - Fax:419-520-3531
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35090648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2843187Medicaid
OH2843187Medicaid
OH2843187Medicaid
OH4239921Medicare PIN
OH9389631Medicare PIN