Basic Information
| Provider Information | |||||||||
| NPI: | 1043469471 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PENUMETSA | ||||||||
| FirstName: | MARUTHI | ||||||||
| MiddleName: | SRIKANTH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4015 GATEWAY BLVD | ||||||||
| Address2: | STE 2120 | ||||||||
| City: | NEWBURGH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476309460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124925457 | ||||||||
| FaxNumber: | 8124644485 | ||||||||
| Practice Location | |||||||||
| Address1: | 4007 GATEWAY BLVD # 100 | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476308947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128420907 | ||||||||
| FaxNumber: | 8124907919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 249875 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | MD452272 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 208M00000X | 249875 | MA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RI0011X | 01078151A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.