Provider Demographics
NPI:1710072087
Name:GANGAHAR, DEEPAK M (MD)
Entity Type:Individual
Prefix:
First Name:DEEPAK
Middle Name:M
Last Name:GANGAHAR
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 1:7440 S 91ST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9797
Mailing Address - Country:US
Mailing Address - Phone:402-489-6555
Mailing Address - Fax:402-328-3770
Practice Address - Street 1:7440 S 91ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9797
Practice Address - Country:US
Practice Address - Phone:402-489-6555
Practice Address - Fax:402-328-3770
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14407208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100126340EMedicaid
NE47070592302Medicaid
NE10026072200Medicaid
NE47070592300Medicaid
NE47070592313Medicaid
NE10026072400Medicaid
NE10026072600Medicaid
IA1969055Medicaid
NE47070592306Medicaid
NE10026072300Medicaid
NE47070592301Medicaid
NE47070592305Medicaid
NE10026072500Medicaid
NE10026072000Medicaid
NE10026072600Medicaid
IA1969055Medicaid
B67726Medicare UPIN
NE47070592313Medicaid
NENA1939034Medicare PIN
NE268228Medicare PIN