Provider Demographics
NPI:1083900328
Name:GANESH, KALYANI (MD)
Entity Type:Individual
Prefix:
First Name:KALYANI
Middle Name:
Last Name:GANESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 JAMES ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2238
Mailing Address - Country:US
Mailing Address - Phone:315-423-5039
Mailing Address - Fax:315-423-5045
Practice Address - Street 1:518 JAMES ST
Practice Address - Street 2:SUITE 160
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2238
Practice Address - Country:US
Practice Address - Phone:315-423-5039
Practice Address - Fax:315-423-5045
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY154862207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine