Provider Demographics
NPI:1871595819
Name:PINNAMANENI, LENIN (MD)
Entity type:Individual
Prefix:DR
First Name:LENIN
Middle Name:
Last Name:PINNAMANENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1297
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:75949-1297
Mailing Address - Country:US
Mailing Address - Phone:936-876-5719
Mailing Address - Fax:936-876-3308
Practice Address - Street 1:106 N US HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:TX
Practice Address - Zip Code:75949-8910
Practice Address - Country:US
Practice Address - Phone:936-876-5719
Practice Address - Fax:936-876-3308
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8981207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110113008OtherMEDICARE RAILROAD
TX80Y930OtherBC/BS INDIVIDUAL #
TX752609790OtherGROUP TAX ID #
TX128249301Medicaid
TX116806OtherCHIPS
TX80Y930Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #
TXB25520Medicare UPIN