Provider Demographics
NPI:1609336734
Name:GHEEWALA, ROHAN ANUP (MD)
Entity Type:Individual
Prefix:
First Name:ROHAN
Middle Name:ANUP
Last Name:GHEEWALA
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 1:47 NEW SCOTLAND AVENUE
Mailing Address - Street 2:DEPARTMENT OF ORTHOPAEDIC SURGERY
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-453-3079
Mailing Address - Fax:518-453-1463
Practice Address - Street 1:47 NEW SCOTLAND AVENUE
Practice Address - Street 2:DEPARTMENT OF ORTHOPAEDIC SURGERY
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-453-3079
Practice Address - Fax:518-453-1463
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
64161390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program