Healthcare Provider Details

I. General information

NPI: 1962516898
Provider Name (Legal Business Name): ANITA GANDHY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 HYDE ST
SAN FRANCISCO CA
94109-4806
US

IV. Provider business mailing address

2100 POWELL ST SUITE 900
EMERYVILLE CA
94608-1826
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-6817
  • Fax: 415-353-6887
Mailing address:
  • Phone: 510-350-2732
  • Fax: 510-879-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA81491
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA81491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: