{
"Npi": {
"NPI": "1629773494",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GANGDIA",
"FirstName": "VOMA",
"MiddleName": "PRYDE",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "CSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GANGDIA",
"OtherFirstName": "VOMA",
"OtherMiddleName": "PRYDE",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "CSW",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "9863 GOOD LUCK RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LANHAM",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20706-3212",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "240-510-7836",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9897 GOOD LUCK RD APT 3",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LANHAM",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20706-3285",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "240-510-7836",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/03/2023",
"LastUpdateDate": "06/20/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "172V00000X",
"TaxonomyName": "Community Health Worker",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "171M00000X",
"TaxonomyName": "Case Manager/Care Coordinator",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}