MEDICARE: ASHOK PENMETSA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	35.060954	OH
2	207RC0000X	Cardiovascular Disease Physician	01049695	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669471322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHOK PENMETSA MD

Provider Business Mailing Address
First Line	:	PO BOX 635283
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-5283
Country	:	US
Telephone Number	:	812-532-2657
Fax Number	:	812-539-4723

Provider Business Practice Location Address
First Line	:	606 WILSON CREEK RD
Second Line	:
City	:	LAWRENCEBURG
State	:	IN
Zip	:	47025-1095
Country	:	US
Telephone Number	:	812-532-2657
Fax Number	:	812-539-4723

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	01/07/2021

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Directions to “ ASHOK PENMETSA MD” Practice Location

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