Provider Demographics
NPI:1225347131
Name:PRADEEP K PANDYA MD INC
Entity Type:Organization
Organization Name:PRADEEP K PANDYA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:K
Authorized Official - Last Name:PANDYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-687-1247
Mailing Address - Street 1:131 N EWING ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3383
Mailing Address - Country:US
Mailing Address - Phone:740-687-1247
Mailing Address - Fax:740-687-3594
Practice Address - Street 1:131 N EWING ST
Practice Address - Street 2:SUITE A
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3383
Practice Address - Country:US
Practice Address - Phone:740-687-1247
Practice Address - Fax:740-687-3594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044049208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35044049OtherLICENSE
OH0400391Medicaid
OH0400391Medicaid
OH35044049OtherLICENSE