Provider Demographics
NPI:1982763918
Name:DINESH R GANDHI MD PA
Entity Type:Organization
Organization Name:DINESH R GANDHI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-773-5469
Mailing Address - Street 1:301PINE ST NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640
Mailing Address - Country:US
Mailing Address - Phone:256-773-5469
Mailing Address - Fax:256-773-5425
Practice Address - Street 1:301 PINE ST NW
Practice Address - Street 2:SUITE A
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-2338
Practice Address - Country:US
Practice Address - Phone:256-773-5469
Practice Address - Fax:256-773-5425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7119174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC73366Medicare UPIN
ALF150Medicare ID - Type Unspecified