Provider Demographics
NPI:1467848622
Name:CHAGANTI, PRANEETHA
Entity Type:Individual
Prefix:
First Name:PRANEETHA
Middle Name:
Last Name:CHAGANTI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:PRANEETHA
Other - Middle Name:
Other - Last Name:CHAGANTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:311 FOREST DR S
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-2310
Mailing Address - Country:US
Mailing Address - Phone:206-601-8505
Mailing Address - Fax:
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:206-601-8505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA106404002080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine