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Individual

DR. PRAMOD REDDY GANTA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2508 N MAIN ST STE G, ANDERSON, SC 29621
(864) 540-8430
(866) 421-1896
Mailing address
2508 N MAIN ST STE G, ANDERSON, SC 29621-3266
(864) 540-8430
(866) 421-1896

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
19517
MS
207RH0003X
Hematology & Oncology Physician
Primary
35066
SC
208M00000X
Hospitalist Physician
19517
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
07502764
MS
05
1124249
LA
01
7460782
AETNA
MS
01
P00417392
RAILROAD MEDICARE
MS
Enumeration date
06/22/2006
Last updated
08/16/2018
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