Provider Demographics
NPI:1669493573
Name:PINNAMANENI, KAVITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITHA
Middle Name:
Last Name:PINNAMANENI
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 1:1202 W FRANK AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3304
Mailing Address - Country:US
Mailing Address - Phone:936-637-6415
Mailing Address - Fax:936-632-9025
Practice Address - Street 1:1202 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3304
Practice Address - Country:US
Practice Address - Phone:936-637-6415
Practice Address - Fax:936-632-9025
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8616207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038230301Medicaid
TX00T37KMedicare PIN
TXB25522Medicare UPIN