Provider Demographics
NPI:1003585498
Name:PANDHARPURKAR, TEJAL HEMANT (BA)
Entity Type:Individual
Prefix:
First Name:TEJAL
Middle Name:HEMANT
Last Name:PANDHARPURKAR
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 SW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2969
Mailing Address - Country:US
Mailing Address - Phone:503-799-6239
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD # OR97239
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3098
Practice Address - Country:US
Practice Address - Phone:503-494-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program