Provider Demographics
NPI:1457405474
Name:GANESH, SADVI (MD)
Entity Type:Individual
Prefix:
First Name:SADVI
Middle Name:
Last Name:GANESH
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 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-8998
Mailing Address - Fax:207-973-7391
Practice Address - Street 1:905 UNION ST STE 9
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3039
Practice Address - Country:US
Practice Address - Phone:207-973-8998
Practice Address - Fax:207-973-7391
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME017292208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation