Basic Information
| Provider Information | |||||||||
| NPI: | 1851705925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANUGANTI | ||||||||
| FirstName: | SRINIVASA | ||||||||
| MiddleName: | CHARI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 ARLINGTON AVE # MS 1050 | ||||||||
| Address2: | GRADUATE MEDICAL EDUCATION | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436142595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193833815 | ||||||||
| FaxNumber: | 4193833098 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 ARLINGTON AVE # MS 1050 | ||||||||
| Address2: | GRADUATE MEDICAL EDUCATION | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436142595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193833815 | ||||||||
| FaxNumber: | 4193833098 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2014 | ||||||||
| LastUpdateDate: | 11/30/2016 | ||||||||
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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 | 2084P0800X | 08-00343 | KS | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.