Healthcare Provider Details

I. General information

NPI: 1619013877
Provider Name (Legal Business Name): KNOX UROLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 COSHOCTON AVE
MT VERNON OH
43050-1947
US

IV. Provider business mailing address

812 COSHOCTON AVE
MT VERNON OH
43050-1947
US

V. Phone/Fax

Practice location:
  • Phone: 740-397-7220
  • Fax: 740-397-0682
Mailing address:
  • Phone: 740-397-7220
  • Fax: 740-397-0682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35042634
License Number StateOH

VIII. Authorized Official

Name: MR. RAMANADHARAO PAMULAPATI
Title or Position: PRESIDENT
Credential: MD
Phone: 740-397-7220