Provider Demographics
NPI:1033420369
Name:PAHUJA, SANDHYA (MD)
Entity Type:Individual
Prefix:
First Name:SANDHYA
Middle Name:
Last Name:PAHUJA
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 1:280 CUMBERLAND TRACE RD
Mailing Address - Street 2:APT. 417
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-9099
Mailing Address - Country:US
Mailing Address - Phone:859-976-5273
Mailing Address - Fax:
Practice Address - Street 1:950 MAIN ST
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-9435
Practice Address - Country:US
Practice Address - Phone:270-524-1201
Practice Address - Fax:270-524-1202
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46015207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100261490Medicaid
KYK146720Medicare PIN
KYK110171Medicare PIN
KYK110170Medicare PIN