Provider Demographics
NPI:1508939067
Name:GANTI, VALLI (MD)
Entity Type:Individual
Prefix:
First Name:VALLI
Middle Name:
Last Name:GANTI
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1265 FRANKLIN AVE
Mailing Address - Street 2:MARTIN LUTHER KING HEALTH CENTER
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1265 FRANKLIN AVE
Practice Address - Street 2:MARTIN LUTHER KING HEALTH CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3501
Practice Address - Country:US
Practice Address - Phone:718-503-7700
Practice Address - Fax:718-503-7755
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2012-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY259829207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI66517Medicare UPIN