Individual
PRASANTHI PASALA GANDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
411 E CHESTNUT ST, LOUISVILLE, KY 40202
(502) 588-3400
(502) 588-3401
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 272-5817
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
47284
KY
2080P0205X
Pediatric Endocrinology Physician
0116028500
VA
2080P0205X
Pediatric Endocrinology Physician
35.134354
OH
390200000X
Student in an Organized Health Care Education/Training Program
0116028500
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201242010
—
IN
05
—
7100212920
—
KY
Enumeration date
03/30/2011
Last updated
06/03/2022
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