Doctor Name: | PRAVEENA GANDIKOTA |
NPI Number: | 1285849513 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | MT 185538 |
Business Practice Address: | One Medical Center Blvd Suite 424 Upland, PA - 19013 |
Business Phone Number: | 6103381820 |
Business Fax Number: | 6103381825 |
Mailing Address: | One Medical Center Blvd, Suite 424 UPLAND |
State: | PA |
Postal Code: | 19013 |
Phone Number: | 6103381820 |
Fax Number: | 6103381825 |
NPI Enumeration Date: | 05/11/2007 |
NPI Last Update Date: | 10/29/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | MT 185538 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | PA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |