Provider Demographics
NPI:1760501308
Name:WAGHRAY-PENMETCHA, TARUNA (MD)
Entity Type:Individual
Prefix:
First Name:TARUNA
Middle Name:
Last Name:WAGHRAY-PENMETCHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TARUNA
Other - Middle Name:WAGHRAY
Other - Last Name:PENMETCHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7810 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-8011
Mailing Address - Country:US
Mailing Address - Phone:630-662-0393
Mailing Address - Fax:
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-106874207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology