Provider Demographics
NPI:1336169283
Name:GANCHAN, RICHARD P (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:GANCHAN
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 1:850 HARVARD WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2055
Mailing Address - Country:US
Mailing Address - Phone:775-982-4590
Mailing Address - Fax:775-982-4595
Practice Address - Street 1:1155 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-982-7878
Practice Address - Fax:775-982-4196
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC40206207RC0000X
NV3198207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXPY183366Medicaid
NV002016415Medicaid
NVCC2332OtherBLUE CROSS BLUE SHIELD
NVV110390Medicare PIN
NVV110367Medicare PIN
NV110073356Medicare PIN
NV002016415Medicaid
NVCC2332OtherBLUE CROSS BLUE SHIELD
CAXPY183366Medicaid
CACA149522Medicare PIN