Provider Demographics
NPI:1073533485
Name:PANDARABOYINA, NAVEEN C (MD)
Entity Type:Individual
Prefix:
First Name:NAVEEN
Middle Name:C
Last Name:PANDARABOYINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MEMORIAL DR STE 114
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2238
Mailing Address - Country:US
Mailing Address - Phone:978-466-4980
Mailing Address - Fax:978-466-4022
Practice Address - Street 1:50 MEMORIAL DRIVE
Practice Address - Street 2:SUITE # 114
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-466-4980
Practice Address - Fax:978-466-4022
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222879207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2087103Medicaid
MA2087103Medicaid
MAA37794Medicare ID - Type Unspecified