Healthcare Provider Details

I. General information

NPI: 1235888546
Provider Name (Legal Business Name): DEEPTHI GANGARAM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 CENTRAL AVE
PHILADELPHIA PA
19111-2442
US

IV. Provider business mailing address

7600 CENTRAL AVE
PHILADELPHIA PA
19111-2442
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS025109
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: