Provider Demographics
NPI:1760499826
Name:GANTI, VINU (MD)
Entity type:Individual
Prefix:DR
First Name:VINU
Middle Name:
Last Name:GANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VINU
Other - Middle Name:
Other - Last Name:GANTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12800 MIDDLEBROOK RD STE 204
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-5254
Mailing Address - Country:US
Mailing Address - Phone:301-540-8146
Mailing Address - Fax:301-540-8162
Practice Address - Street 1:12800 MIDDLEBROOK ROAD SUITE # 204
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5262
Practice Address - Country:US
Practice Address - Phone:301-540-8146
Practice Address - Fax:301-540-8162
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD411G2207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD349721000Medicaid
419049Medicare ID - Type Unspecified
F20027Medicare UPIN