Healthcare Provider Details

I. General information

NPI: 1922007038
Provider Name (Legal Business Name): SAI B GANDHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 NEW SCOTLAND RD SUITE 303
SLINGERLANDS NY
12159-9208
US

IV. Provider business mailing address

PO BOX 358
LATHAM NY
12110-0358
US

V. Phone/Fax

Practice location:
  • Phone: 518-533-6565
  • Fax: 518-533-6567
Mailing address:
  • Phone: 518-533-6565
  • Fax: 518-533-6567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number207325
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: