Healthcare Provider Details

I. General information

NPI: 1710543962
Provider Name (Legal Business Name): RAHUL PAMARTHY M.B.B.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 KENNY RD
COLUMBUS OH
43221-3502
US

IV. Provider business mailing address

101 W UNIVERSITY AVE
CHAMPAIGN IL
61820-3909
US

V. Phone/Fax

Practice location:
  • Phone: 407-314-3125
  • Fax:
Mailing address:
  • Phone: 217-366-6162
  • Fax: 217-366-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036177418
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: