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General NPI Number Information
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NPI Number | 1982653127
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Entity Type | Organization
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Legal Business Name | MOHAN PENMETCHA, M.D., P.A.
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Dates
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Enumeration Date | 05/07/2006
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 4217 MARSH RIDGE RD STE 110
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City | CARROLLTON
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State | TX
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Zip | 75010-4416
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Country | US
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Telephone | 972-307-3456
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Fax | 972-307-6789
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Provider Business Mailing Address
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Address Line | 4217 MARSH RIDGE RD STE 110
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City | CARROLLTON
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State | TX
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Zip | 75010-4416
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Country | US
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Telephone | 972-307-3456
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Fax | 972-307-6789
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MOHAN PENMETCHA
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Credential | M.D.
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Telephone | 972-492-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | J9779
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License Number State | TX
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