Provider Demographics
NPI:1013967595
Name:GANAPATHY, PADMAVATHI SWAMINATHAN (MD)
Entity Type:Individual
Prefix:
First Name:PADMAVATHI
Middle Name:SWAMINATHAN
Last Name:GANAPATHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PADMA
Other - Middle Name:
Other - Last Name:IYENGAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4986 N ADAMS RD
Mailing Address - Street 2:STE C
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-1416
Mailing Address - Country:US
Mailing Address - Phone:248-475-5601
Mailing Address - Fax:248-475-5632
Practice Address - Street 1:4986 N ADAMS RD
Practice Address - Street 2:STE C
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-1416
Practice Address - Country:US
Practice Address - Phone:248-475-5601
Practice Address - Fax:248-475-5632
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070624208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H65304Medicare UPIN