Provider Demographics
NPI:1053133793
Name:ANNE ARUNDEL GASTROENTEROLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:ANNE ARUNDEL GASTROENTEROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PRAVEENA
Authorized Official - Middle Name:GANNI
Authorized Official - Last Name:VELAMATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-224-2116
Mailing Address - Street 1:820 BESTGATE RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 ANNAPOLIS RD STE 201
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1349
Practice Address - Country:US
Practice Address - Phone:410-224-2116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty