Provider Demographics
NPI:1174500128
Name:GHAMANDE, SHARAD ANANT (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARAD
Middle Name:ANANT
Last Name:GHAMANDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1120 15TH ST
Mailing Address - Street 2:GEORGIA REGENTS MEDICAL ASSOCIATES
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-3992
Mailing Address - Fax:706-721-9777
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:GEORGIA REGENTS MEDICAL ASSOCIATES
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-3993
Practice Address - Fax:706-721-9777
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA049173174400000X
GA207VX0201X207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG49173Medicaid
GA00876675DMedicaid
GA2166545OtherUNITED HEALTHCARE
GA7398139OtherAETNA
GA559555OtherBLUE CROSS BLUE SHIELD
SCG49173Medicaid
GA7398139OtherAETNA