Provider Demographics
NPI:1386604452
Name:PENTA, PRAMILA (MD)
Entity type:Individual
Prefix:
First Name:PRAMILA
Middle Name:
Last Name:PENTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 GARDENVILLE PKWY W
Mailing Address - Street 2:C/O CREDENTIALING
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1324
Mailing Address - Country:US
Mailing Address - Phone:716-857-6150
Mailing Address - Fax:716-656-4074
Practice Address - Street 1:120 GARDENVILLE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1324
Practice Address - Country:US
Practice Address - Phone:716-668-3600
Practice Address - Fax:716-656-4274
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN44378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000530953001OtherBLUECROSS BLUESHIELD WNY
NY115366OtherINDEPENDENT HEALTH
NY081124000086OtherFIDELIS
NY1386604452OtherUNIVERA
NY1544090OtherGOLDCHOICE
NY235201BFOtherMVP
NY7956417OtherAETNA
NY1386604452OtherUNIVERA