Provider Demographics
NPI:1962516898
Name:GANDHY, ANITA (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:GANDHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 POWELL ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1826
Mailing Address - Country:US
Mailing Address - Phone:510-350-2732
Mailing Address - Fax:510-879-9130
Practice Address - Street 1:900 HYDE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4806
Practice Address - Country:US
Practice Address - Phone:415-353-6817
Practice Address - Fax:415-353-6887
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81491207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A814911OtherBCBS - CA
CA00A814910OtherBCBS - CA
CA00A814910Medicaid
CAP00472044OtherRR MEDICARE
CA00A814910OtherBCBS - CA
CA00A814911OtherBCBS - CA