Individual
DR. RAZ DILIP PENMATCHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1310 24TH AVE S, NASHVILLE, TN 37212
(615) 875-6000
Mailing address
1310 24TH AVE S, NASHVILLE, TN 37212-2637
(563) 328-5694
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
202259
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-104091
ILLINOIS LICENSE
IL
01
—
26568
IA GROUP MEDICARE
IA
01
—
790730
IL GROUP MEDICARE
IL
Enumeration date
04/26/2006
Last updated
12/20/2018
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