Individual
DR. PREETAM GONGIDI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O., M.H.S.
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0300
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-0937
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
OT016084
PA
2085R0202X
Diagnostic Radiology Physician
345512
LA
2085R0202X
Diagnostic Radiology Physician
34798
MS
2085R0202X
Diagnostic Radiology Physician
Primary
R3089
TX
Other
Enumeration date
05/23/2011
Last updated
06/20/2025
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