DR. PREETAM GONGIDI (NPI# 1902199185) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902199185 |
| Entity Type | Individual |
| Full Name | DR. PREETAM GONGIDI |
| Credential | D.O., M.H.S. |
| Practice Address |
815 Pennsylvania Ave Fort Worth TX 76104-2224 |
| Mailing Address |
816 W Cannon St Fort Worth TX 76104-3146 |
| Practice Telephone | 8173210300 |
| Mailing Telephone | (817) 321-0937 |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2017-08-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085P0229X |
Radiology Specialization: Pediatric Radiology |
OT016084 | PA | Allopathic & Osteopathic Physicians |
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
R3089 | TX | Allopathic & Osteopathic Physicians |
| Street Address |
815 PENNSYLVANIA AVE |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76104-2224 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184627994 | David A Fenyes | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2005-05-24 |
| 1457972853 | Robert W Pasquini Jr. | Physician Assistant | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2020-04-27 |
| 1396215059 | Rebeca Ji Hae Kim Stanley | Physician Assistant | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2018-11-26 |
| 1710423884 | Isuri Weerasinghe | Physician Assistant | 815 Pennsylvania Ave, Fort Worth, TX 76104 | 2017-01-13 |
| 1255759437 | Ali Alian | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2014-04-03 |
| 1396166039 | Health Imaging Partners, LLC | Physiological Laboratory | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2013-12-24 |
| 1427482280 | Magda Rizer I | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104 | 2013-08-29 |
| 1033556311 | Vivek Gowdra Halappa | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2013-05-28 |
| 1194169847 | Justin Manuel Ramirez | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2013-04-24 |
| 1508209495 | Ethan Boothe | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2013-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669082186 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 1115 8th St, Fort Worth, TX 76104 | 2020-08-10 |
| 1992343693 | Iris Giove | Psychologist | John Peter Smith Hospital, 1500 S. Main St., Fort Worth, TX 76104 | 2019-12-13 |
| 1104480656 | Swarnalaxmi Umapathy | Student in an Organized Health Care Education/Training Program | 900 8th Avenue, Fort Worth, TX 76104 | 2019-04-30 |
| 1881189132 | Mega Surgical Assistants LLC | Specialist/Technologist, Other | 1301pennsylvania, Fort Worth, TX 76104 | 2018-06-28 |
| 1356848899 | Tricia Kelly | Nurse Practitioner | 1325 Pennsylvania Avenue Suite 560, Fort Worth, TX 76104 | 2018-04-11 |
| 1952820979 | Modern Vein Clinic | Internal Medicine | 757 8th Avenue, Suite A, Forth Worth, TX 76104 | 2017-09-11 |
| 1790207165 | Vanessa Abbood | Dietitian, Registered | 900 Eighth Ave, Fns Department, Fort Worth, TX 76104 | 2017-07-07 |
| 1922537562 | Nicole Marie Tod | Student in an Organized Health Care Education/Training Program | 1500 S Main Street, Fort Worth, TX 76104 | 2017-06-07 |
| 1770025934 | Micah Bonola | Chiropractor | 1300 W. Rosedale St, Ste. A, Fort Worth, TX 76104 | 2016-11-04 |
| 1518315894 | United Bioscience, LLC. | Clinical Medical Laboratory | 901 W. Leuda St., B, Fort Worth, TX 76104 | 2016-05-27 |
| Find all providers in zip 76104 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619389392 | Thomas Fikar | Radiology | 8216 Deerwood Forest Dr, Fort Worth, TX 76126-5181 | 2014-05-29 |
| 1487939328 | Fort Worth Radiology, Pllc | Radiology | 2603 8th Ave Ste D, Suite D, Fort Worth, TX 76110-3000 | 2011-10-11 |
| 1730331380 | Steven L. Hsu | Radiology | 5750 Stratum Dr, Fort Worth, TX 76137-2757 | 2008-10-15 |
| 1841468360 | Walworth Edward Burge | Radiology | 815 Pennsylvainia Ave, Fort Worth, TX 76104-2224 | 2008-02-19 |
| 1306034699 | Pin Point Radiology Management Seaford Pa | Radiology | 1412 W Magnolia Ave, Suite 100, Fort Worth, TX 76104-4378 | 2007-10-11 |
| 1689897977 | Stephen Melvyn Lobo | Radiology | 815 Pennsylvania Avenue, Fort Worth, TX 76104-2224 | 2007-04-11 |
| 1235269119 | Texas Health Care, P.l.l.c. | Radiology | 3800 Hulen, Suite 100, Fort Worth, TX 76107-7270 | 2007-03-07 |
| 1245360171 | Texas Health Care, P.l.l.c. | Radiology | 800 W Magnolia Ave Ste 100, Fort Worth, TX 76104-4611 | 2007-03-07 |
| 1932254679 | Envision Imaging of North Fort Worth | Radiology | 4232 Heritage Trace Pkwy, Fort Worth, TX 76244-5375 | 2007-01-24 |
| 1033160015 | Monticello Diagnostic Imaging Lp | Radiology | 3712 W 7th Street, Suite A, Fort Worth, TX 76107 | 2006-05-13 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.