Provider Demographics
NPI:1508330010
Name:GANGULY, ARUPA (PHD)
Entity Type:Individual
Prefix:
First Name:ARUPA
Middle Name:
Last Name:GANGULY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 HAMILTON WALK
Mailing Address - Street 2:415 ANATOMY AND CHEMISTRY BLDG
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-573-3020
Mailing Address - Fax:215-573-5940
Practice Address - Street 1:3620 HAMILTON WALK
Practice Address - Street 2:415 ANATOMY AND CHEMISTRY BLDG
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-573-3020
Practice Address - Fax:215-573-5940
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA23148A207SG0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics