Provider Demographics
NPI:1992736524
Name:GANESH RADIOLOGY LLC
Entity type:Organization
Organization Name:GANESH RADIOLOGY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEELAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:ATIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-809-6442
Mailing Address - Street 1:10801 LOCKWOOD DR STE 170
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1559
Mailing Address - Country:US
Mailing Address - Phone:301-592-0727
Mailing Address - Fax:301-592-0728
Practice Address - Street 1:10801 LOCKWOOD DR. SUITE 140
Practice Address - Street 2:COLEWOOD CENTER
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901
Practice Address - Country:US
Practice Address - Phone:301-592-0727
Practice Address - Fax:301-592-0728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCFDUVN1Medicare PIN