Provider Demographics
NPI:1396732996
Name:GANGOLI, AMIT HARSH (MD)
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:HARSH
Last Name:GANGOLI
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 1:649 N LEWIS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1234
Mailing Address - Country:US
Mailing Address - Phone:610-481-9600
Mailing Address - Fax:610-481-0225
Practice Address - Street 1:649 N LEWIS RD STE 220
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-1234
Practice Address - Country:US
Practice Address - Phone:610-481-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069250L207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386393OtherHIGHMARK BLUE SHIELD
PAH35481Medicare UPIN