Provider Demographics
NPI:1477521524
Name:SASHIDHAR V. GANTA MD PA
Entity Type:Organization
Organization Name:SASHIDHAR V. GANTA MD PA
Other - Org Name:AUSTIN INSTITUTE OF BARIATRICS AND LAPAROSCOPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SASHIDHAR
Authorized Official - Middle Name:V
Authorized Official - Last Name:GANTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-244-6452
Mailing Address - Street 1:PO BOX 200185
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78720-0185
Mailing Address - Country:US
Mailing Address - Phone:512-244-6452
Mailing Address - Fax:512-244-6582
Practice Address - Street 1:3407 WELLS BRANCH PKWY
Practice Address - Street 2:SUITE 625
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6632
Practice Address - Country:US
Practice Address - Phone:512-244-6452
Practice Address - Fax:512-244-6582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2325208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH58340Medicare UPIN
TX00W087Medicare ID - Type UnspecifiedGROUP #
TX8F2203Medicare ID - Type UnspecifiedDR. GANTA'S IND. #