Provider Demographics
NPI:1669457206
Name:DAS, ANANYA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANANYA
Middle Name:
Last Name:DAS
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 1:3707 N 7TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5059
Mailing Address - Country:US
Mailing Address - Phone:480-507-5678
Mailing Address - Fax:480-507-5677
Practice Address - Street 1:2680 S VAL VISTA DR STE 116
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2154
Practice Address - Country:US
Practice Address - Phone:480-507-5678
Practice Address - Fax:480-507-5677
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33355207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ893124Medicaid
H66065Medicare UPIN
Z147551Medicare PIN
AZZ136498Medicare PIN