Basic Information
| Provider Information | |||||||||
| NPI: | 1972098663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PUNNA | ||||||||
| FirstName: | SRIVANI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1448 10TH AVENUE | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257013579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046918722 | ||||||||
| FaxNumber: | 3046918591 | ||||||||
| Practice Location | |||||||||
| Address1: | 1249 15TH STREET | ||||||||
| Address2: | SUITE 2000 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257013662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046911000 | ||||||||
| FaxNumber: | 3046911693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2018 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 30187 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.