Provider Demographics
NPI:1619084761
Name:GHADE, GIRISH VASANT (MD)
Entity Type:Individual
Prefix:DR
First Name:GIRISH
Middle Name:VASANT
Last Name:GHADE
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 730096
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32173-0096
Mailing Address - Country:US
Mailing Address - Phone:386-506-8910
Mailing Address - Fax:
Practice Address - Street 1:909 BIG TREE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-2517
Practice Address - Country:US
Practice Address - Phone:386-506-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060057A207R00000X
FLME 107681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG81830Medicare UPIN