Provider Demographics
NPI:1922007038
Name:GANDHAM, SAI B (MD)
Entity Type:Individual
Prefix:DR
First Name:SAI
Middle Name:B
Last Name:GANDHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-0358
Mailing Address - Country:US
Mailing Address - Phone:518-533-6565
Mailing Address - Fax:518-533-6567
Practice Address - Street 1:1220 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 303
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9208
Practice Address - Country:US
Practice Address - Phone:518-533-6565
Practice Address - Fax:518-533-6567
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207325207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00333162OtherRAILROAD MEDICARE
NY10021519OtherCDPHP
NY346081OtherMVP
NY01752872Medicaid
NY10021519OtherCDPHP