Provider Demographics
NPI:1376537100
Name:PANDO, DALIA (MD)
Entity Type:Individual
Prefix:DR
First Name:DALIA
Middle Name:
Last Name:PANDO
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 1:132 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2926
Mailing Address - Country:US
Mailing Address - Phone:973-450-0624
Mailing Address - Fax:973-450-0626
Practice Address - Street 1:132 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2926
Practice Address - Country:US
Practice Address - Phone:973-450-0624
Practice Address - Fax:973-450-0626
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06824700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7839804Medicaid
NJG88312Medicare UPIN
NJ7839804Medicaid
NJ024886VAEMedicare PIN