Provider Demographics
NPI:1740245604
Name:MASSAND, GHANSHYAM PRIBDHAS (MD)
Entity Type:Individual
Prefix:DR
First Name:GHANSHYAM
Middle Name:PRIBDHAS
Last Name:MASSAND
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 981147
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-1147
Mailing Address - Country:US
Mailing Address - Phone:435-630-3329
Mailing Address - Fax:435-655-8269
Practice Address - Street 1:6531 NORTH LANDMARK DRIVE
Practice Address - Street 2:SUITE E
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098
Practice Address - Country:US
Practice Address - Phone:435-630-3329
Practice Address - Fax:435-655-8269
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6150961-1205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1740245604Medicaid
A59694Medicare UPIN
UT1740245604Medicaid
UT6017780001Medicare NSC
UT1740245604Medicare PIN