Provider Demographics
NPI:1033479209
Name:GANESH, DERVI (MD)
Entity Type:Individual
Prefix:
First Name:DERVI
Middle Name:
Last Name:GANESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DERVI
Other - Middle Name:
Other - Last Name:GANESH-BALUYOT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2514 GERTRUDE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2530
Mailing Address - Country:US
Mailing Address - Phone:561-350-5619
Mailing Address - Fax:
Practice Address - Street 1:211 E BOYNTON BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-3839
Practice Address - Country:US
Practice Address - Phone:561-732-3200
Practice Address - Fax:561-732-6849
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129154207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology