MEDICARE: DR. SASHIDHAR V. GANTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	M2325	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821060807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SASHIDHAR V. GANTA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 200185
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78720-0185
Country	:	US
Telephone Number	:	512-244-6452
Fax Number	:	512-244-6582

Provider Business Practice Location Address
First Line	:	11851 JOLLYVILLE RD STE 4
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-2350
Country	:	US
Telephone Number	:	512-952-0341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	05/10/2023

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