Provider Demographics
NPI:1609005578
Name:GANGADHARAMURTHY, DAKSHIN (MD)
Entity Type:Individual
Prefix:
First Name:DAKSHIN
Middle Name:
Last Name:GANGADHARAMURTHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAKSHINAMURTHY
Other - Middle Name:
Other - Last Name:GANGADHARAMURTHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1000, DEPT 351
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-758-9900
Mailing Address - Fax:901-752-2335
Practice Address - Street 1:4250 BETHEL RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-8737
Practice Address - Country:US
Practice Address - Phone:901-516-1290
Practice Address - Fax:901-516-1220
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26693207R00000X, 208M00000X
TN61443207R00000X, 208M00000X
OH35.138598207RC0000X
MA247776208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist