Provider Demographics
NPI:1326015587
Name:GANJOO, JESSIE (MD)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:
Last Name:GANJOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:575 COAL VALLEY RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3724
Mailing Address - Country:US
Mailing Address - Phone:412-466-2220
Mailing Address - Fax:412-466-4048
Practice Address - Street 1:160 WAYLAND SMITH DR STE 102
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-7500
Practice Address - Country:US
Practice Address - Phone:724-438-3300
Practice Address - Fax:724-438-3366
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD426877207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101352181Medicaid
PA1013521810008Medicaid
PA093522Medicare ID - Type Unspecified