Provider Demographics
NPI:1063482644
Name:GANGWER, JOAN R (MS,RD,CDE,LDN)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:R
Last Name:GANGWER
Suffix:
Gender:F
Credentials:MS,RD,CDE,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-4923
Mailing Address - Country:US
Mailing Address - Phone:215-588-6970
Mailing Address - Fax:
Practice Address - Street 1:2300 COMPUTER RD
Practice Address - Street 2:SUITE H-39
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1752
Practice Address - Country:US
Practice Address - Phone:215-588-6970
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001580133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered