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1265451470 NPI number — DIDA K. GANJOO M.D.

NPI Number: 1265451470
Health Care Provider/Practitioner: DIDA K. GANJOO M.D.

Information about “1265451470” NPI (DIDA K. GANJOO M.D.) exists in 1265451470 in HTML format HTML  |  1265451470 in plain Text format TXT  |  1265451470 in PDF (Portable Document Format) PDF  |  1265451470 in an XML format XML  formats.

NPI Number : 1265451470 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265451470",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GANJOO",
    "FirstName": "DIDA",
    "MiddleName": "K.",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SOOD-GANJOO",
    "OtherFirstName": "DIDA",
    "OtherMiddleName": "K.",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "M.D.",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "3060 MITCHELLVILLE RD",
    "SecondLineMailingAddress": "SUITE 104",
    "MailingAddressCityName": "BOWIE",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "20716-1389",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "301-218-4220",
    "MailingAddressFaxNumber": "301-218-4330",
    "FirstLinePracticeLocationAddress": "3060 MITCHELLVILLE RD",
    "SecondLinePracticeLocationAddress": "SUITE 104",
    "PracticeLocationAddressCityName": "BOWIE",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "20716-1389",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "301-218-4220",
    "PracticeLocationAddressFaxNumber": "301-218-4330",
    "EnumerationDate": "07/19/2006",
    "LastUpdateDate": "12/23/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2084P0800X",
        "TaxonomyName": "Psychiatry Physician",
        "LicenseNumber": "D0036532",
        "LicenseNumberStateCode": "MD",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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