Basic Information
| Provider Information | |||||||||
| NPI: | 1962516898 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANDHY | ||||||||
| FirstName: | ANITA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 POWELL ST | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | EMERYVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946081826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103502732 | ||||||||
| FaxNumber: | 5108799130 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 HYDE ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941094806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153536817 | ||||||||
| FaxNumber: | 4153536887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 11/15/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A81491 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00472044 | 01 | CA | RR MEDICARE | OTHER | 00A814910 | 05 | CA | MEDICAID | 00A814911 | 01 | CA | BCBS - CA | OTHER | 00A814910 | 01 | CA | BCBS - CA | OTHER |