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General NPI Number Information
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NPI Number | 1316101272
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Entity Type | Individual
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Provider Name | DEEPA GANESHAN MD
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Gender | Female
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 12398 FM 423 STE 600
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City | FRISCO
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State | TX
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Zip | 75033-0158
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Country | US
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Telephone | 214-494-4622
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Fax |
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Provider Business Mailing Address
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Address Line | 12398 FM 423 STE 600
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City | FRISCO
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State | TX
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Zip | 75033-0158
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Country | US
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Telephone | 214-494-4622
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Fax | 214-494-4609
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 017942
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License Number State | ME
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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 | 2002-0360
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | R3514
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License Number State | TX
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