Provider Demographics
NPI:1033185772
Name:GANATRA, JYOTSOM BIPIN (MD MPU)
Entity Type:Individual
Prefix:
First Name:JYOTSOM
Middle Name:BIPIN
Last Name:GANATRA
Suffix:
Gender:M
Credentials:MD MPU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2423
Mailing Address - Country:US
Mailing Address - Phone:603-668-2020
Mailing Address - Fax:603-668-0881
Practice Address - Street 1:250 RIVER RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2423
Practice Address - Country:US
Practice Address - Phone:603-668-2020
Practice Address - Fax:603-668-0881
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12903207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
954007378NH01OtherANTHEM
NH30205198Medicaid
I90296Medicare UPIN
NH30205198Medicaid