Provider Demographics
NPI:1518254721
Name:GANESAN, UMA (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:UMA
Middle Name:
Last Name:GANESAN
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:972-232-8080
Mailing Address - Fax:800-281-9558
Practice Address - Street 1:8000 FRANKFORD RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-6834
Practice Address - Country:US
Practice Address - Phone:972-232-8080
Practice Address - Fax:800-281-9558
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX587561363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDO7564OtherPALMETTO RR
TX2845281-01Medicaid
TX858N27OtherBCBS
TX0016SHOtherBCBS
TXP00969508OtherPALMETTO RR
TXTXB134667Medicare PIN