Provider Demographics
NPI:1790944866
Name:DONTINENI, PAVAN VENKATA (MD)
Entity Type:Individual
Prefix:DR
First Name:PAVAN
Middle Name:VENKATA
Last Name:DONTINENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6449 HERB GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8633
Mailing Address - Country:US
Mailing Address - Phone:740-877-0478
Mailing Address - Fax:
Practice Address - Street 1:6400 E BROAD ST STE 400
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2979
Practice Address - Country:US
Practice Address - Phone:614-655-3345
Practice Address - Fax:614-317-4689
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0994112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0069253Medicaid
OHH135132Medicare PIN