Provider Demographics
NPI:1558347039
Name:GANDHI, SANJAY M (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:M
Last Name:GANDHI
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:PO BOX 31
Mailing Address - Street 2:959 WYOMING AVE.
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18501-0031
Mailing Address - Country:US
Mailing Address - Phone:570-344-3517
Mailing Address - Fax:570-344-6839
Practice Address - Street 1:959 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-3023
Practice Address - Country:US
Practice Address - Phone:570-344-3517
Practice Address - Fax:570-344-6839
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064359L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014179740001Medicaid
PAG17839Medicare UPIN
PA1014179740001Medicaid