Provider Demographics
NPI:1568408870
Name:PANDYA, KIRTI J (MD)
Entity Type:Individual
Prefix:MR
First Name:KIRTI
Middle Name:J
Last Name:PANDYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5106 N ARMENIA AVE
Mailing Address - Street 2:#3
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1433
Mailing Address - Country:US
Mailing Address - Phone:813-353-0900
Mailing Address - Fax:813-353-0802
Practice Address - Street 1:5106 N ARMENIA AVE
Practice Address - Street 2:#3
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1433
Practice Address - Country:US
Practice Address - Phone:813-353-0900
Practice Address - Fax:813-353-0802
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL592912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055057400Medicaid
FL12504Medicare ID - Type Unspecified
FLA64322Medicare UPIN