Provider Demographics
NPI:1528148947
Name:PENMETSA, SANTHI (MD)
Entity type:Individual
Prefix:
First Name:SANTHI
Middle Name:
Last Name:PENMETSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E AVENUE G #1358
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-3039
Mailing Address - Country:US
Mailing Address - Phone:972-972-4443
Mailing Address - Fax:972-972-4470
Practice Address - Street 1:423 E MAIN ST
Practice Address - Street 2:STE 1
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-3345
Practice Address - Country:US
Practice Address - Phone:972-972-4443
Practice Address - Fax:972-972-4470
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9634207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043939001Medicaid
TX8556J8Medicare PIN
TX080159650Medicare PIN
TX043939001Medicaid