Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | MD17150 | ME |
Y | 207RP1001X | Pulmonary Disease | MD17150 | ME |
NPI | 1063443752 |
---|---|
Provider Name | Dr. Ganesha Santhyadka |
First Address | Lewiston, ME 04243-7291 |
Second Address | Bangor, ME 04401-3979 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 03/02/2022 |