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General NPI Number Information
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NPI Number | 1235174855
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Entity Type | Individual
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Provider Name | GANGA PINGILI PA
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Gender | Female
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 10/02/2015
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Provider Practice Location Address
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Address Line | 2835 82ND AVE SE STE 210
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City | MERCER ISLAND
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State | WA
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Zip | 98040-3055
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Country | US
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Telephone | 206-236-3030
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Fax | 206-204-0808
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Provider Business Mailing Address
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Address Line | 2835 82ND AVE SE STE 210
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City | MERCER ISLAND
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State | WA
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Zip | 98040-3055
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Country | US
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Telephone | 206-236-3030
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Fax | 206-204-0808
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 60188439
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License Number State | WA
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