Provider Demographics
NPI:1326015587
Name:GANJOO, JESSIE (MD)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:
Last Name:GANJOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-1955
Mailing Address - Country:US
Mailing Address - Phone:724-877-2214
Mailing Address - Fax:
Practice Address - Street 1:765 LIBERTY ST STE 307A
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2566
Practice Address - Country:US
Practice Address - Phone:814-333-3945
Practice Address - Fax:814-333-3947
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426877207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101352181Medicaid
PA1013521810008Medicaid
PA093522Medicare ID - Type Unspecified