Provider Demographics
NPI:1831122969
Name:GANGAR, ANITA SHAH (DO)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:SHAH
Last Name:GANGAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12514 STRATFORD GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1558
Mailing Address - Country:US
Mailing Address - Phone:301-622-0266
Mailing Address - Fax:
Practice Address - Street 1:7676 NEW HAMPSHIRE AVENUE
Practice Address - Street 2:SUITE 220A
Practice Address - City:TACOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912
Practice Address - Country:US
Practice Address - Phone:301-431-2972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0062859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine