Provider Demographics
NPI:1821164369
Name:GANESHAPPA, KANCHANA (MD)
Entity Type:Individual
Prefix:
First Name:KANCHANA
Middle Name:
Last Name:GANESHAPPA
Suffix:
Gender:F
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 2104
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:NH
Mailing Address - Zip Code:03854-2104
Mailing Address - Country:US
Mailing Address - Phone:832-721-1067
Mailing Address - Fax:
Practice Address - Street 1:90 LITTLE HARBOR RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:NH
Practice Address - Zip Code:03854-2104
Practice Address - Country:US
Practice Address - Phone:832-721-1067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD18346207L00000X
NH16218207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology