Provider Demographics
NPI:1801462833
Name:PANUGANTI, PRANATI LAXMI (MD)
Entity type:Individual
Prefix:
First Name:PRANATI
Middle Name:LAXMI
Last Name:PANUGANTI
Suffix:
Gender:F
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:CAMPUS BOX 7593
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7593
Mailing Address - Country:US
Mailing Address - Phone:919-966-3172
Mailing Address - Fax:919-966-8419
Practice Address - Street 1:118 KNOX WAY
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-6610
Practice Address - Country:US
Practice Address - Phone:984-205-4603
Practice Address - Fax:984-215-5941
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
NCPANU-L8K1WB390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program