Provider Demographics
NPI:1548587439
Name:PENMETSA, RAMAKRISHNARAJU
Entity Type:Individual
Prefix:
First Name:RAMAKRISHNARAJU
Middle Name:
Last Name:PENMETSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1762 MERRITT BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-3212
Mailing Address - Country:US
Mailing Address - Phone:410-282-4020
Mailing Address - Fax:410-282-4664
Practice Address - Street 1:1762 MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-3212
Practice Address - Country:US
Practice Address - Phone:410-282-4020
Practice Address - Fax:410-282-4664
Is Sole Proprietor?:No
Enumeration Date:2010-05-01
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist