Healthcare Provider Details

I. General information

NPI: 1669445391
Provider Name (Legal Business Name): MANDIRA D GHAREKHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 THEALL RD THE WESTCHESTER MEDICAL GROUP
RYE NY
10580-1404
US

IV. Provider business mailing address

2700 WESTCHESTER AVE THE WESTCHESTER MEDICAL GROUP
PURCHASE NY
10577
US

V. Phone/Fax

Practice location:
  • Phone: 914-848-8700
  • Fax: 914-848-8701
Mailing address:
  • Phone: 914-681-3110
  • Fax: 914-682-6403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number220327
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: