Provider Demographics
NPI:1093899189
Name:VINU GANTI M.D., P.C.
Entity Type:Organization
Organization Name:VINU GANTI M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINU
Authorized Official - Middle Name:
Authorized Official - Last Name:GANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-540-8146
Mailing Address - Street 1:19529 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-5262
Mailing Address - Country:US
Mailing Address - Phone:301-540-8146
Mailing Address - Fax:301-540-8162
Practice Address - Street 1:19529 DOCTORS DR
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherGROUP TAX ID#