Provider Demographics
NPI:1285845370
Name:SANGHI, PRAMOD (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAMOD
Middle Name:
Last Name:SANGHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10706 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1813
Mailing Address - Country:US
Mailing Address - Phone:718-323-2229
Mailing Address - Fax:
Practice Address - Street 1:437 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4201
Practice Address - Country:US
Practice Address - Phone:646-707-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430207RC0000X
NY264079207RC0000X, 207RI0011X
MI4301089866207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301089866OtherMEDICAL LICENSE
1194838383OtherGROUP NPI
0H23923OtherBCBSM PIN
MI1285845370Medicaid
0H23923OtherBCBSM PIN
0H23923OtherBCBSM PIN