Individual provider Active NPI

Nisha Ganesh, D.D.S.

  • General Practice Dentistry
  • Baltimore, MD
National Provider Identifier
1053580514
Registry record updated Mar 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
14195 Issued in MD
Practice address
650 W Baltimore St # 3205
Baltimore, MD 21201-1510
Phone
(410) 706-7961
NPI assigned
Feb 28, 2008
Last updated
Mar 14, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 14195 MD Primary

Addresses

Primary practice location

650 W Baltimore St # 3205
Baltimore, MD 21201-1510

Mailing address

650 W Baltimore St # 3205
Baltimore, MD 21201-1510
Phone (240) 688-1874

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160119001973 NC Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6103129523

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14195MDMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1053580514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 W BALTIMORE ST # 3205",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011510",
            "telephone_number": "240-688-1874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 W BALTIMORE ST # 3205",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011510",
            "telephone_number": "410-706-7961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANESH",
        "first_name": "NISHA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-28",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "14195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.