Provider Demographics
NPI:1780630343
Name:NANNAPANENI, INDIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:INDIRA
Middle Name:
Last Name:NANNAPANENI
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 1:2606 WALES AVE NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2340
Mailing Address - Country:US
Mailing Address - Phone:330-834-4000
Mailing Address - Fax:
Practice Address - Street 1:2606 WALES AVE NW
Practice Address - Street 2:SUITE 100
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2340
Practice Address - Country:US
Practice Address - Phone:330-834-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-7887 N207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2185291Medicaid
OHPR9344061OtherMEDICARE GROUP ID
OH2185291Medicaid
OHPR9344061OtherMEDICARE GROUP ID