Provider Demographics
NPI:1851624787
Name:KANNA, SOWJANYA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOWJANYA
Middle Name:
Last Name:KANNA
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 1:301 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-1858
Mailing Address - Country:US
Mailing Address - Phone:724-224-3113
Mailing Address - Fax:724-224-2447
Practice Address - Street 1:301 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-1858
Practice Address - Country:US
Practice Address - Phone:724-224-3113
Practice Address - Fax:724-224-2447
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD462002207RG0100X
OH57. 015926208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103351129Medicaid
14098931OtherCAQH