Provider Demographics
NPI:1487679213
Name:GANGI, SUMANA (MD)
Entity Type:Individual
Prefix:
First Name:SUMANA
Middle Name:
Last Name:GANGI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6044 ROYAL CRESR DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3874
Mailing Address - Country:US
Mailing Address - Phone:214-909-8904
Mailing Address - Fax:
Practice Address - Street 1:1621 N. BELTLINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149
Practice Address - Country:US
Practice Address - Phone:972-682-5700
Practice Address - Fax:972-682-5703
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07612100207R00000X
NY232547207RE0101X
TXM4788207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine