Individual
JOYCE RAO PANGANAMALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
11029 MONTGOMERY RD, CINCINNATI, OH 45249-2306
(513) 891-2211
(513) 891-2218
Mailing address
PO BOX 637676, CINCINNATI, OH 45263-7676
(513) 853-4749
(513) 853-4743
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
AP2134
MA
363A00000X
Physician Assistant
Primary
50.004010RX
OH
363AM0700X
Medical Physician Assistant
50.004010
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0462231
—
OH
05
—
2565399
—
OH
Enumeration date
05/02/2007
Last updated
11/04/2021
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