Provider Demographics
NPI:1316025943
Name:VADLAMANI, GITA (MD)
Entity Type:Individual
Prefix:
First Name:GITA
Middle Name:
Last Name:VADLAMANI
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 1:16 DUNLEITH DR
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124
Mailing Address - Country:US
Mailing Address - Phone:314-877-0755
Mailing Address - Fax:314-877-0868
Practice Address - Street 1:5351 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-3146
Practice Address - Country:US
Practice Address - Phone:314-877-0755
Practice Address - Fax:314-877-0868
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1C19207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine