Provider Demographics
NPI:1568443273
Name:GANDHI, DINESH R (MD)
Entity Type:Individual
Prefix:
First Name:DINESH
Middle Name:R
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 1:50 MARQUIS RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6477
Mailing Address - Country:US
Mailing Address - Phone:207-865-6131
Mailing Address - Fax:207-865-9399
Practice Address - Street 1:236 FORSYTH ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3786
Practice Address - Country:US
Practice Address - Phone:404-521-2410
Practice Address - Fax:877-411-0199
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00007119207R00000X
MEEL191035207R00000X
GA74119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51528853OtherBCBS
C73366Medicare UPIN
AL51528853OtherBCBS