Provider Demographics
NPI:1669532180
Name:GANNINGER, MARIA VIRGINIA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:VIRGINIA
Last Name:GANNINGER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412049
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2049
Mailing Address - Country:US
Mailing Address - Phone:314-525-0580
Mailing Address - Fax:314-525-0581
Practice Address - Street 1:3844 S LINDBERGH BLVD
Practice Address - Street 2:STE 216
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1416
Practice Address - Country:US
Practice Address - Phone:314-525-0580
Practice Address - Fax:314-525-0581
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003005862208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208829929Medicaid
MO1669532180Medicaid