Individual
GANGADHARA R KABBLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1243 PENNSYLVANIA AVE, PINE CITY, NY 14871
(607) 734-6281
(607) 734-4409
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
262909
NY
207RC0000X
Cardiovascular Disease Physician
Primary
262909
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03397880
—
NY
05
—
1032498220002
—
PA
Enumeration date
01/31/2007
Last updated
07/31/2018
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