Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 207VX0201X | GA |
NPI | 1174500128 |
---|---|
Provider Name | Dr. Sharad Anant Ghamande |
First Address | Augusta, GA 30912-0004 |
Second Address | Augusta, GA 30912-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 14/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00876675D | (05) | GA |
2166545 | UNITED HEALTHCARE (01) | GA |
559555 | BLUE CROSS BLUE SHIELD (01) | GA |
7398139 | AETNA (01) | GA |
G49173 | (05) | SC |
H21638 | (02) | GA |