Healthcare Provider Details

I. General information

NPI: 1386191419
Provider Name (Legal Business Name): JHANSI R GANESAN, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8355 CHERRY LN
LAUREL MD
20707-4829
US

IV. Provider business mailing address

8355 CHERRY LANE
LAUREL MD
20707
US

V. Phone/Fax

Practice location:
  • Phone: 301-725-4341
  • Fax: 301-317-9070
Mailing address:
  • Phone: 301-725-4341
  • Fax: 301-317-9070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JHANSI R GANESAN
Title or Position: PRESIDENT
Credential: M.D
Phone: 301-725-4341