Provider Demographics
NPI:1619186681
Name:GANTA, NEELIMA NAGABATTULA (MD)
Entity Type:Individual
Prefix:
First Name:NEELIMA
Middle Name:NAGABATTULA
Last Name:GANTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NEELIMA
Other - Middle Name:
Other - Last Name:NAGABATTULA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2901 MONTOPOLIS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-6411
Mailing Address - Country:US
Mailing Address - Phone:512-978-9901
Mailing Address - Fax:
Practice Address - Street 1:2901 MONTOPOLIS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-6411
Practice Address - Country:US
Practice Address - Phone:512-978-9901
Practice Address - Fax:512-901-9765
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine