Healthcare Provider Details

I. General information

NPI: 1396732996
Provider Name (Legal Business Name): AMIT HARSH GANGOLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N HENDERSON RD STE 310
KING OF PRUSSIA PA
19406-2155
US

IV. Provider business mailing address

170 N HENDERSON RD STE 310
KING OF PRUSSIA PA
19406-2155
US

V. Phone/Fax

Practice location:
  • Phone: 610-481-9600
  • Fax:
Mailing address:
  • Phone: 610-481-9600
  • Fax: 610-481-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD069250L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: