Provider Demographics
NPI:1306897434
Name:MURALI, GANESAN (MD)
Entity type:Individual
Prefix:
First Name:GANESAN
Middle Name:
Last Name:MURALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:3701 CORRIERE RD STE 23
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-7991
Practice Address - Country:US
Practice Address - Phone:610-402-9116
Practice Address - Fax:610-402-9610
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057516L207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001855061Medicaid
H45976Medicare UPIN
0000050244Medicare ID - Type Unspecified