MEDICARE: MRS. SUDHATHI CHENNURU M.D.

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	207RH0003X	Hematology & Oncology Physician	35.082992	OH
2	207RH0003X	Hematology & Oncology Physician	Q1965	TX
3	207RH0003X	Hematology & Oncology Physician	35184146	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689740326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUDHATHI CHENNURU M.D.

Provider Business Mailing Address
First Line	:	1 PRESTIGE PL STE 550
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-6115
Country	:	US
Telephone Number	:	937-762-1310
Fax Number	:	375-228-0689

Provider Business Practice Location Address
First Line	:	3700 SOUTHERN BLVD STE 401
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-1265
Country	:	US
Telephone Number	:	855-500-2873
Fax Number	:	937-281-3913

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	02/01/2024

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Directions to “ MRS. SUDHATHI CHENNURU M.D.” Practice Location

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