Provider Demographics
NPI:1043576366
Name:NELACANTI, VIDYA (MD)
Entity Type:Individual
Prefix:
First Name:VIDYA
Middle Name:
Last Name:NELACANTI
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 1:6005 MONCLOVA RD
Mailing Address - Street 2:ST LUKE'S HOSPITAL FAMILY MEDICINE
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1864
Mailing Address - Country:US
Mailing Address - Phone:419-383-5522
Mailing Address - Fax:
Practice Address - Street 1:6005 MONCLOVA RD
Practice Address - Street 2:ST LUKE'S HOSPITAL FAMILY MEDICINE
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1864
Practice Address - Country:US
Practice Address - Phone:419-383-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program