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General NPI Number Information
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NPI Number | 1306135389
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Entity Type | Individual
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Provider Name | PRASANTHI PASALA GANDHAM M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 411 E CHESTNUT ST
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City | LOUISVILLE
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State | KY
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Zip | 40202
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Country | US
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Telephone | 502-588-3400
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Fax | 502-588-3401
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Provider Business Mailing Address
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Address Line | PO BOX 776879
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City | CHICAGO
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State | IL
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Zip | 60677-6879
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Country | US
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Telephone | 502-272-5817
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Fax | 502-272-5339
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 0116028500
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 47284
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | 0116028500
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | 35.134354
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License Number State | OH
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