Provider Demographics
NPI:1841369519
Name:GANGARAM, BALRAM (MD)
Entity type:Individual
Prefix:DR
First Name:BALRAM
Middle Name:
Last Name:GANGARAM
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 1:550 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2545
Mailing Address - Country:US
Mailing Address - Phone:415-476-2757
Mailing Address - Fax:415-476-9305
Practice Address - Street 1:UCSF, 550 16TH STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-1001
Practice Address - Country:US
Practice Address - Phone:808-983-8387
Practice Address - Fax:808-945-1570
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA155846207SG0201X
HIMD-12641208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIG39277Medicare UPIN