Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 12903 | NH |
NPI | 1033185772 |
---|---|
Provider Name | Jyotsom Bipin Ganatra |
First Address | Manchester, NH 03104-2423 |
Second Address | Manchester, NH 03104-2423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30205198 | (05) | NH |
954007378NH01 | ANTHEM (01) | |
I90296 | (02) |