Provider Demographics
NPI:1477534204
Name:GARUDA, SANJAY R (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:R
Last Name:GARUDA
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 1:3820 OLENTANGY RIVER RD
Mailing Address - Street 2:OHIO GASTROENTEROLOGY GROUP INC
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-5403
Mailing Address - Country:US
Mailing Address - Phone:614-457-1213
Mailing Address - Fax:614-457-9519
Practice Address - Street 1:3820 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-5403
Practice Address - Country:US
Practice Address - Phone:614-457-1213
Practice Address - Fax:614-457-9517
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087037207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2609332Medicaid
4172041Medicare PIN
OH2609332Medicaid