Provider Demographics
NPI:1306211834
Name:KANUGANTI, LIKITHA (MD)
Entity Type:Individual
Prefix:
First Name:LIKITHA
Middle Name:
Last Name:KANUGANTI
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 1:2132 WALLACE AVE
Mailing Address - Street 2:APT 242
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2573
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 WATERFORD DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-8268
Practice Address - Country:US
Practice Address - Phone:717-591-3630
Practice Address - Fax:717-591-3631
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD470290207R00000X
NY295169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty