Provider Demographics
NPI:1982761417
Name:VELAMATI, PRAVEENA GANNI (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAVEENA
Middle Name:GANNI
Last Name:VELAMATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PRAVEENA
Other - Middle Name:
Other - Last Name:GANNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:820 BESTGATE ROAD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-224-2116
Mailing Address - Fax:410-224-2118
Practice Address - Street 1:820 BESTGATE RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-224-2116
Practice Address - Fax:410-224-2118
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP19619207RG0100X
MDD0066902207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD415006600Medicaid