Provider Demographics
NPI:1962818286
Name:GANENTHIRAN, PRIYANTHIE (MD)
Entity Type:Individual
Prefix:
First Name:PRIYANTHIE
Middle Name:
Last Name:GANENTHIRAN
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 1:720 ESKENAZI AVENUE
Mailing Address - Street 2:FIFTH THIRD BANK BLDG., 5TH FLOOR
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5166
Mailing Address - Country:US
Mailing Address - Phone:317-880-3851
Mailing Address - Fax:317-880-0343
Practice Address - Street 1:9443 E 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-2132
Practice Address - Country:US
Practice Address - Phone:317-890-2100
Practice Address - Fax:317-890-2171
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01077985A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300005051Medicaid