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Individual

PADMAJA R TANNERU

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
7657 E MAIN ST, REYNOLDSBURG, OH 43068-1243
(614) 865-8500
Mailing address
120 MCMILLEN DR, NEWARK, OH 43055-1809
(220) 564-1765
(220) 564-1766

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35.088340
OH
207R00000X
Internal Medicine Physician
Primary
35088340
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2674155
OH
Enumeration date
08/02/2006
Last updated
08/29/2019
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