Provider Demographics
NPI:1619107620
Name:GORANTLA, NEELIMA (MD)
Entity type:Individual
Prefix:DR
First Name:NEELIMA
Middle Name:
Last Name:GORANTLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NEELIMA
Other - Middle Name:
Other - Last Name:RAVIPATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:793 W STATE ST
Mailing Address - Street 2:MSB-3RD FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1551
Mailing Address - Country:US
Mailing Address - Phone:614-234-1079
Mailing Address - Fax:614-234-2772
Practice Address - Street 1:793 W STATE ST
Practice Address - Street 2:MSB-3RD FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1551
Practice Address - Country:US
Practice Address - Phone:614-234-1079
Practice Address - Fax:614-234-2772
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1262932085R0202X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program