Provider Demographics
NPI:1902434624
Name:CHANNAMSETTY, PADMINI (DO)
Entity type:Individual
Prefix:DR
First Name:PADMINI
Middle Name:
Last Name:CHANNAMSETTY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:860-972-9034
Mailing Address - Fax:860-972-7040
Practice Address - Street 1:280 S MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3112
Practice Address - Country:US
Practice Address - Phone:860-696-2925
Practice Address - Fax:860-696-2926
Is Sole Proprietor?:No
Enumeration Date:2020-03-29
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT77992208VP0000X, 207Q00000X
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program