Provider Demographics
NPI:1982228763
Name:PONNEKANTI, SRAVAN KUMAR
Entity Type:Individual
Prefix:DR
First Name:SRAVAN
Middle Name:KUMAR
Last Name:PONNEKANTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:INTERNAL MEDICINE RESIDENCY/ GUTHRIE ROBERT PACKER HOSP
Mailing Address - Street 2:ONE GUTHRIE SQUARE
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1603
Mailing Address - Country:US
Mailing Address - Phone:570-887-4559
Mailing Address - Fax:
Practice Address - Street 1:INTERNAL MEDICINE RESIDENCY/ GUTHRIE ROBERT PACKER HOSP
Practice Address - Street 2:ONE GUTHRIE SQUARE
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1603
Practice Address - Country:US
Practice Address - Phone:570-887-4559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT220206390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program