Provider Demographics
NPI:1386191419
Name:GANESAN,JHANSI R. MD, PC
Entity Type:Organization
Organization Name:GANESAN,JHANSI R. MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JHANSI
Authorized Official - Middle Name:R
Authorized Official - Last Name:GANESAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-725-4341
Mailing Address - Street 1:8355 CHERRY LANE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707
Mailing Address - Country:US
Mailing Address - Phone:301-725-4341
Mailing Address - Fax:301-317-9070
Practice Address - Street 1:8355 CHERRY LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4829
Practice Address - Country:US
Practice Address - Phone:301-725-4341
Practice Address - Fax:301-317-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD208000000X - PEDIATR2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD153661300Medicaid