MEDICARE: VANI DANDOLU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MD-062757-L	PA
2	207V00000X	Obstetrics & Gynecology Physician	14114	NV
3	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	14114	NV
4	207VG0400X	Gynecology Physician	14114	NV
5	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	MD062757L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1205824224	OTHER	NV	MEDICARE PPAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205824224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANI DANDOLU MD

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4903
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:	570-271-6578

Provider Business Practice Location Address
First Line	:	1155 E MOUNTAIN BLVD
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-7906
Country	:	US
Telephone Number	:	570-808-7916
Fax Number	:	570-808-6006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/30/2020

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Directions to “ VANI DANDOLU MD” Practice Location

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