Healthcare Provider Details

I. General information

NPI: 1821164369
Provider Name (Legal Business Name): KANCHANA GANESHAPPA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 LITTLE HARBOR RD
NEW CASTLE NH
03854-2104
US

IV. Provider business mailing address

PO BOX 2104
NEW CASTLE NH
03854-2104
US

V. Phone/Fax

Practice location:
  • Phone: 832-721-1067
  • Fax:
Mailing address:
  • Phone: 832-721-1067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD18346
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number16218
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: