Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MT223512 | PA |
NPI | 1013585793 |
---|---|
Provider Name | Tej Ganti |
First Address | Reading, PA 19612-3579 |
Second Address | West Reading, PA 19611-2143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2021 |
Last Update Date | 17/06/2021 |