Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 14114 | NV |
N | 207V00000X | Obstetrician & Gynecologist | MD-062757-L | PA |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 14114 | NV |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD062757L | PA |
N | 207VG0400X | Gynecologist | 14114 | NV |
NPI | 1205824224 |
---|---|
Provider Name | Vani Dandolu |
First Address | Danville, PA 17822-4903 |
Second Address | Wilkes Barre, PA 18702-7906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 30/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0016590140008 | (05) | PA |
1205824224 | (05) | NV |
1205824224 | MEDICARE PPAN (01) | NV |
G57318 | (02) |