Healthcare Provider Details

I. General information

NPI: 1285520858
Provider Name (Legal Business Name): GANGA BASKOTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 REYNOLDSBURG NEW ALBANY RD
BLACKLICK OH
43004-9613
US

IV. Provider business mailing address

702 REYNOLDSBURG NEW ALBANY RD
BLACKLICK OH
43004-9613
US

V. Phone/Fax

Practice location:
  • Phone: 614-558-7319
  • Fax:
Mailing address:
  • Phone: 614-558-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number522056
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: