Provider Demographics
NPI:1235174855
Name:PINGILI, GANGA (PA)
Entity Type:Individual
Prefix:
First Name:GANGA
Middle Name:
Last Name:PINGILI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 82ND AVE SE STE 210
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3055
Mailing Address - Country:US
Mailing Address - Phone:206-236-3030
Mailing Address - Fax:206-204-0808
Practice Address - Street 1:2835 82ND AVE SE STE 210
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3055
Practice Address - Country:US
Practice Address - Phone:206-236-3030
Practice Address - Fax:206-204-0808
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60188439363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA621341781AMedicaid
GA003130OtherSTATE OF GEORGIA
GA003130OtherSTATE OF GEORGIA
GA621341781AMedicaid