Provider Demographics
NPI:1588812978
Name:GANGADHARAN, PALLIYATH N (MD)
Entity Type:Individual
Prefix:
First Name:PALLIYATH
Middle Name:N
Last Name:GANGADHARAN
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 1:650 S ZEDIKER AVE
Mailing Address - Street 2:UNITED HEALTH CENTER
Mailing Address - City:PARLIER
Mailing Address - State:CA
Mailing Address - Zip Code:93648-2666
Mailing Address - Country:US
Mailing Address - Phone:661-849-2781
Mailing Address - Fax:
Practice Address - Street 1:650 S ZEDIKER AVE
Practice Address - Street 2:UNITED HEALTH CENTER
Practice Address - City:PARLIER
Practice Address - State:CA
Practice Address - Zip Code:93648-2666
Practice Address - Country:US
Practice Address - Phone:661-849-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine