Provider Demographics
NPI:1821300401
Name:GHIMIRE, PRAJESH MANI (MD)
Entity Type:Individual
Prefix:
First Name:PRAJESH
Middle Name:MANI
Last Name:GHIMIRE
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 1:113 DEANNA CT
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1333
Mailing Address - Country:US
Mailing Address - Phone:518-330-2843
Mailing Address - Fax:
Practice Address - Street 1:2 TOMMY LUTHER DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6054
Practice Address - Country:US
Practice Address - Phone:518-581-0892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-01067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine