Individual
DR. VANITHA BANAJJAR REVANASIDDAPPA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1718 E 4TH ST STE 907, CHARLOTTE, NC 28204-3282
(704) 372-4000
(704) 334-4855
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
2025-01298
NC
207V00000X
Obstetrics & Gynecology Physician
A162179
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669856217
—
CA
Enumeration date
07/14/2015
Last updated
10/28/2025
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