MEDICARE: SIRISHA PERUMANDLA 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	207RH0003X	Hematology & Oncology Physician	35.152265	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1700891454	OTHER	TRICARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	25031	OTHER	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1700891454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIRISHA PERUMANDLA MD

Provider Business Mailing Address
First Line	:	4300 ALLEN RD
Second Line	:
City	:	STOW
State	:	OH
Zip	:	44224-1032
Country	:	US
Telephone Number	:	330-344-6505
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 ALLEN RD
Second Line	:
City	:	STOW
State	:	OH
Zip	:	44224-1032
Country	:	US
Telephone Number	:	330-344-6505
Fax Number	:	330-344-6431

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	01/16/2025

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Directions to “ SIRISHA PERUMANDLA MD” Practice Location

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