Provider Demographics
NPI:1184183980
Name:NEKKANTI, SRI HARITHA VARDHINI (MD)
Entity Type:Individual
Prefix:DR
First Name:SRI HARITHA
Middle Name:VARDHINI
Last Name:NEKKANTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5601 LOCH RAVEN BLVD, RUSSELL MORGAN BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239
Mailing Address - Country:US
Mailing Address - Phone:443-444-5600
Mailing Address - Fax:
Practice Address - Street 1:5601 LOCH RAVEN BLVD, RUSSELL MORGAN BDG,
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239
Practice Address - Country:US
Practice Address - Phone:443-444-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0095056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty