Vanitha Banajjar Revanasiddappa, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Charlotte, NC
NPI 1669856217 · NPPES record last updated Oct 28, 2025
Key facts
- NPI
- 1669856217
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 2025-01298 (NC)
- Practice address
- 1718 E 4TH St Ste 907
Charlotte, NC 28204-3282 - Phone
- (704) 372-4000
- Fax
- (704) 334-4855
- NPI assigned
- Jul 14, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 32
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Novant Health Medical Group, LLC
Golden Valley Health Centers
Practice addresses (Care Compare)
14330 Oakhill Park LN
Suite 140
Huntersville, NC 28078-3480
Phone (704) 316-3496
797 W Childs Ave
Merced, CA 95341-6805
Phone (209) 722-4842
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191021003200 | CA | Practitioner - Obstetrics/Gynecology | 0941532188 | Reassigns benefits to 1 organization |
| I20251008001499 | NC | Practitioner - Obstetrics/Gynecology | 0941532188 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2025-01298 | NC | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Novant Health Medical Group, LLC | Obstetrics & Gynecology | Current |
Accepting new patients |
| Novant Health Medical Group, LLC | Current | Accepting new patients | |
| Golden Valley Health Center | Current | Accepting new patients | |
| Golden Valley Health Center | Current | Accepting new patients | |
| Golden Valley Health Center | Current | Accepting new patients | |
| Golden Valley Health Center | Current | Accepting new patients | |
| Novant Health Medical Group, LLC | Obstetrics & Gynecology | Current |
Accepting new patients |
| Novant Health Medical Group, LLC | Current | Accepting new patients | |
| Golden Valley Health Center | Current |
Accepting new patients | |
| Golden Valley Health Center | Current | Accepting new patients | |
| Golden Valley Health Center | Current | Accepting new patients | |
| Novant Health Medical Group, LLC | Obstetrics & Gynecology | Current |
Accepting new patients |
| Golden Valley Health Center | Current | Accepting new patients | |
| Golden Valley Health Center | Current | Accepting new patients | |
| Golden Valley Health Center | Current | Accepting new patients | |
| Golden Valley Health Center | Current | Accepting new patients | |
| Golden Valley Health Center | Current | Accepting new patients | |
| Golden Valley Health Centers | Current | Accepting new patients | |
| Golden Valley Health Centers | Current |
Accepting new patients | |
| Novant Health Medical Group, LLC | Past | Accepting new patients |
Locations (25 of 40)
1405 California Ave
Dos Palos, CA 93620
Phone (209) 392-2111
13161 Jefferson St
Le Grand, CA 95333
Phone (209) 389-1900
821 Texas Ave
Los Banos, CA 93635
Phone (209) 385-5481
250 Northgate Dr
Manteca, CA 95336
Phone (209) 239-5299
797 W Childs Ave
Merced, CA 95341
Phone (209) 383-5871
737 W Childs Ave
Merced, CA 95341
Phone (209) 383-1848
3940 Sandpiper Ave
Merced, CA 95340
Phone (209) 381-4104
847 W Childs Ave
Merced, CA 95341
Phone (209) 383-7441
2101 Tenaya Dr
Modesto, CA 95354
Phone (209) 576-6766
1500 Florida Ave
Modesto, CA 95350
Phone (209) 571-5071
1114 6th St
Modesto, CA 95354
Phone (209) 576-2845
1121 Hammond St
Modesto, CA 95351
Phone (209) 576-4437
637 Merced St
Newman, CA 95360
Phone (209) 862-0270
200 C St
Patterson, CA 95363
Phone (209) 892-6307
9235 E Broadway St
Planada, CA 95365
Phone (209) 382-0253
4150 Patterson Rd
Riverbank, CA 95367
Phone (209) 863-3900
1200 W Main St
Turlock, CA 95380
Phone (209) 668-5388
6324 Fairview Rd
Ste 430
Charlotte, NC 28210
Phone (704) 316-3148
8820 Rachel Freeman Way
Charlotte, NC 28278
Phone (704) 316-3608
1918 Randolph Rd
Ste 670
Charlotte, NC 28207
Phone (704) 334-9535
15825 Ballantyne Medical Pl
Ste 200
Charlotte, NC 28277
Phone (704) 384-1925
2711 Randolph Rd
Ste 512
Charlotte, NC 28207
Phone (704) 333-4101
8201 Healthcare Loop
Ste 302
Charlotte, NC 28215
Phone (704) 316-2319
1718 E 4th St
Ste 907
Charlotte, NC 28204
Phone (704) 372-4000
10905 Providence Rd W
Ste 260
Charlotte, NC 28277
Phone (704) 542-0744
Interoperability endpoints
- vbanajjarrevanasiddappa1728642@direct.novanthealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 2025-01298 | NC | Yes |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Obstetrics & Gynecology Physician | 207V00000X | A162179 | CA |
Addresses
Primary practice location
1718 E 4TH St Ste 907
Charlotte, NC 28204-3282
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Other practice location 1
797 W Childs Ave
Merced, CA 95341-6805
Phone (866) 682-4842
Other practice location 2
1650 Grand Concourse
Dept of Ob/Gyn
Bronx, NY 10457-7606
Phone (718) 579-3992
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669856217 | Medicaid | CA |
Other names
- Dr. Vanitha Banajjar
Other providers in Charlotte, NC
- Cesilia Baltazar
- Kristine Baltazar
- Jonathan Robert Baltzell
- Kayla Bamberg
- Daniel Andrew Bambini
- Zuzana Rajecka Banas
- Mohammad Fawzy Banawan
- Gaetan Banawoe
- Leonid Banchik
- Berita Banda
All providers in Charlotte, NC · Obstetrics & Gynecology Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.