Provider Demographics
NPI:1609946029
Name:PANDAPAS, MARK GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:GEORGE
Last Name:PANDAPAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 SUNSET WAY
Mailing Address - Street 2:
Mailing Address - City:MUIR BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:94965-9752
Mailing Address - Country:US
Mailing Address - Phone:510-847-8200
Mailing Address - Fax:414-389-5081
Practice Address - Street 1:27200 CALAROGA AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4339
Practice Address - Country:US
Practice Address - Phone:510-264-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60995207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0042170Medicaid
CA00G609950Medicare ID - Type UnspecifiedMEDICARE NO.
CAGR0042170Medicaid