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General NPI Number Information
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NPI Number | 1174718076
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Entity Type | Individual
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Provider Name | SHANTI PORTIA GANESH MD, MPH
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Gender | Female
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 1540 SPRING VALLEY DR PM&R DEPARTMENT (117)
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City | HUNTINGTON
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State | WV
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Zip | 25704-9300
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Country | US
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Telephone | 304-429-6741
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Fax |
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Provider Business Mailing Address
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Address Line | 1540 SPRING VALLEY DR PM&R DEPARTMENT (117)
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City | HUNTINGTON
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State | WV
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Zip | 25704-9300
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Country | US
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Telephone | 304-429-6741
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 125050793
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036123418
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 27395
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License Number State | WV
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