Provider Demographics
NPI:1437460516
Name:AMOD P TENDULKAR MD INC
Entity Type:Organization
Organization Name:AMOD P TENDULKAR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMOD
Authorized Official - Middle Name:P
Authorized Official - Last Name:TENDULKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-948-1234
Mailing Address - Street 1:1617 N CALIFORNIA ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6117
Mailing Address - Country:US
Mailing Address - Phone:209-948-1234
Mailing Address - Fax:209-462-9233
Practice Address - Street 1:1617 N CALIFORNIA ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6117
Practice Address - Country:US
Practice Address - Phone:209-948-1234
Practice Address - Fax:209-462-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81369208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty