Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 19477 | SC |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 19477 | SC |
N | 2081P2900X | Pain Medicine | 19477 | SC |
N | 2081S0010X | Sports Medicine | 19477 | SC |
N | 213ES0000X | Sports Medicine | 19477 | SC |
NPI | 1447308689 |
---|---|
Provider Name | Dr. Ashish Gajanan Shanbhag |
First Address | Spartanburg, SC 29304-6012 |
Second Address | Woodbridge, VA 22191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2007 |
Last Update Date | 23/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
194774 | (05) | SC |
722-522 | (05) | SC |
F91473 | (02) | SC |