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General NPI Number Information
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NPI Number | 1710231402
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Entity Type | Individual
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Provider Name | PRASANTH GANESAN MD
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Gender | Male
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Dates
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Enumeration Date | 11/01/2012
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 1400 HOLCOMBE BLVD INV CANCER THERAPEUTICS, MD ANDERSON CANCER CENTER
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City | HOUSTON
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State | TX
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Zip | 77030-4008
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Country | US
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Telephone | 713-563-8965
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Fax | 713-792-5553
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Provider Business Mailing Address
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Address Line | 1400 HOLCOMBE BLVD UNIT 0455, PO BOX 301402
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City | HOUSTON
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State | TX
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Zip | 77030-4008
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Country | US
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Telephone | 713-563-8965
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Fax | 713-792-5553
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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 | BP10044597
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License Number State | TX
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