Basic Information
| Provider Information | |||||||||
| NPI: | 1235102138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANGU | ||||||||
| FirstName: | GEETHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1625 STRAITS TPKE | ||||||||
| Address2: | SUITE #201 | ||||||||
| City: | MIDDLEBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067621805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035739512 | ||||||||
| FaxNumber: | 2035682904 | ||||||||
| Practice Location | |||||||||
| Address1: | 64 ROBBINS ST | ||||||||
| Address2: | SIXTH FLOOR | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067082613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035736263 | ||||||||
| FaxNumber: | 2035736030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 039564 | CT | X | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 039564 | CT | X | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.