Healthcare Provider Details

I. General information

NPI: 1780818773
Provider Name (Legal Business Name): PRASANTI GANNI VACHHANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PRASANTI GANNI

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DR
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

2500 METROHEALTH DR
CLEVELAND OH
44109-1900
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-7800
  • Fax:
Mailing address:
  • Phone: 216-778-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0077477
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: