Provider Demographics
NPI:1346878220
Name:SRINIVASAN, GANESH (MBBS, MD)
Entity Type:Individual
Prefix:DR
First Name:GANESH
Middle Name:
Last Name:SRINIVASAN
Suffix:
Gender:M
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 IRETON PLACE
Mailing Address - Street 2:
Mailing Address - City:WINNIPEG
Mailing Address - State:MB
Mailing Address - Zip Code:R3P2P8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WN 2610, NEONATOLOGY
Practice Address - Street 2:820 SHERBROOK STREET
Practice Address - City:WINNIPEG
Practice Address - State:MB
Practice Address - Zip Code:R3A1R9
Practice Address - Country:CA
Practice Address - Phone:204-981-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY363322080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty