Provider Demographics
NPI:1508838731
Name:VANGANI, VEENA N (MD)
Entity Type:Individual
Prefix:DR
First Name:VEENA
Middle Name:N
Last Name:VANGANI
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 1:4604 SPOTSYLVANIA PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7763
Mailing Address - Country:US
Mailing Address - Phone:540-423-6600
Mailing Address - Fax:540-423-6655
Practice Address - Street 1:4604 SPOTSYLVANIA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7763
Practice Address - Country:US
Practice Address - Phone:540-423-6600
Practice Address - Fax:540-423-6655
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-228194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005875129Medicaid
110008431Medicare ID - Type Unspecified
H21867Medicare UPIN
VA005875129Medicaid
VA017873C18Medicare PIN