Provider Demographics
NPI:1023065927
Name:VELIGANDLA, HIMACHALA R (MD)
Entity type:Individual
Prefix:DR
First Name:HIMACHALA
Middle Name:R
Last Name:VELIGANDLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:308 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4716
Mailing Address - Country:US
Mailing Address - Phone:352-726-8353
Mailing Address - Fax:352-726-5038
Practice Address - Street 1:5000 KY ROUTE 321
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-889-6210
Practice Address - Fax:606-889-6291
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME104390207RC0000X
KY40110207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100008680Medicaid