Provider Demographics
NPI:1669415022
Name:GALA, SANJIV JAYANT (MD)
Entity type:Individual
Prefix:
First Name:SANJIV
Middle Name:JAYANT
Last Name:GALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SANJIV
Other - Middle Name:JAYANT
Other - Last Name:GALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5475 RINGS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-7537
Mailing Address - Country:US
Mailing Address - Phone:614-210-1890
Mailing Address - Fax:614-210-1886
Practice Address - Street 1:3036 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4128
Practice Address - Country:US
Practice Address - Phone:419-473-0431
Practice Address - Fax:419-471-2460
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-9695-G2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH77563Medicare UPIN