Provider Demographics
NPI:1518198308
Name:KOMMOORI, SNEHA LATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SNEHA LATHA
Middle Name:
Last Name:KOMMOORI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 BRIGHAM DR STE 200
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7117
Practice Address - Country:US
Practice Address - Phone:567-585-0380
Practice Address - Fax:567-585-0381
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.127705207RI0200X
OH35127705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0193125OtherOH MEDICAID
OHH528530OtherOH MEDICARE