MEDICARE: VEERAIAH C PERNI 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	207L00000X	Anesthesiology Physician	3542003P	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	PENDING	OTHER	OH	MEDICARE PTAN
3	106076VGE	OTHER	PA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	10830301	OTHER	CAQH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316932775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VEERAIAH C PERNI MD

Provider Business Mailing Address
First Line	:	4135 BOARDMAN CANFIELD RD STE 101
Second Line	:
City	:	CANFIELD
State	:	OH
Zip	:	44406-9803
Country	:	US
Telephone Number	:	330-286-5330
Fax Number	:	330-286-5396

Provider Business Practice Location Address
First Line	:	425 W 5TH ST
Second Line	:
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-2405
Country	:	US
Telephone Number	:	330-286-5330
Fax Number	:	330-286-5396

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	03/17/2018

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Directions to “ VEERAIAH C PERNI MD” Practice Location

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