Provider Demographics
NPI:1821400052
Name:VENIGALLA, MEENA N (MD)
Entity Type:Individual
Prefix:DR
First Name:MEENA
Middle Name:N
Last Name:VENIGALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEENA
Other - Middle Name:N
Other - Last Name:ELANCHENNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2112 HARRISBURG PIKE
Mailing Address - Street 2:STE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2664
Mailing Address - Country:US
Mailing Address - Phone:717-544-3059
Mailing Address - Fax:717-544-3638
Practice Address - Street 1:2112 HARRISBURG PIKE
Practice Address - Street 2:STE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2664
Practice Address - Country:US
Practice Address - Phone:717-544-3059
Practice Address - Fax:717-544-3638
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD459782207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program