Provider Demographics
NPI:1710231402
Name:GANESAN, PRASANTH (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASANTH
Middle Name:
Last Name:GANESAN
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 1:1400 HOLCOMBE BLVD
Mailing Address - Street 2:UNIT 0455, PO BOX 301402
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4008
Mailing Address - Country:US
Mailing Address - Phone:713-563-8965
Mailing Address - Fax:713-792-5553
Practice Address - Street 1:1400 HOLCOMBE BLVD
Practice Address - Street 2:INV CANCER THERAPEUTICS, MD ANDERSON CANCER CENTER
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4008
Practice Address - Country:US
Practice Address - Phone:713-563-8965
Practice Address - Fax:713-792-5553
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10044597390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program