Healthcare Provider Details

I. General information

NPI: 1043469471
Provider Name (Legal Business Name): SRIKANTH PENUMETSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARUTHI PENUMETSA MD

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 GATEWAY BLVD
NEWBURGH IN
47630-8900
US

IV. Provider business mailing address

PO BOX 632111
CINCINNATI OH
45263-2111
US

V. Phone/Fax

Practice location:
  • Phone: 812-842-0907
  • Fax: 812-490-7051
Mailing address:
  • Phone: 812-450-6815
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number01078151A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number249875
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number249875
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD452272
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01078151A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: