Provider Demographics
NPI:1699920991
Name:PENUMALLI, VIKRAM REDDY (MD)
Entity type:Individual
Prefix:
First Name:VIKRAM
Middle Name:REDDY
Last Name:PENUMALLI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 29568
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27429-9568
Mailing Address - Country:US
Mailing Address - Phone:336-273-2511
Mailing Address - Fax:336-370-0287
Practice Address - Street 1:912 THIRD STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6967
Practice Address - Country:US
Practice Address - Phone:336-273-2511
Practice Address - Fax:336-370-0287
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2021-09-20
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Provider Licenses
StateLicense IDTaxonomies
NC2010-013532084D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic Neuroimaging