Healthcare Provider Details

I. General information

NPI: 1962142588
Provider Name (Legal Business Name): ANITA R GANDHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST STE 230
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

230 ERWIN RD
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-935-2725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026-01752
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: