Provider Demographics
NPI:1629773494
Name:GANGDIA, VOMA PRYDE (CSW)
Entity Type:Individual
Prefix:MR
First Name:VOMA
Middle Name:PRYDE
Last Name:GANGDIA
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:DR
Other - First Name:VOMA
Other - Middle Name:PRYDE
Other - Last Name:GANGDIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:9863 GOOD LUCK RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3212
Mailing Address - Country:US
Mailing Address - Phone:240-510-7836
Mailing Address - Fax:
Practice Address - Street 1:9897 GOOD LUCK RD APT 3
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3285
Practice Address - Country:US
Practice Address - Phone:240-510-7836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker