Provider Demographics
NPI:1083239792
Name:PANDYA, KRUTARTH KANDARP
Entity Type:Individual
Prefix:
First Name:KRUTARTH
Middle Name:KANDARP
Last Name:PANDYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0002
Mailing Address - Country:US
Mailing Address - Phone:216-636-2035
Mailing Address - Fax:
Practice Address - Street 1:1350 EAST MARKET STREET 7TH FLOOR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483
Practice Address - Country:US
Practice Address - Phone:330-841-9647
Practice Address - Fax:330-841-9645
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2023-07-28
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-03-08
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.148443208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program