Provider Demographics
NPI:1619086782
Name:PANDIAN, NATESA G (MD)
Entity Type:Individual
Prefix:DR
First Name:NATESA
Middle Name:G
Last Name:PANDIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NATESA
Other - Middle Name:G
Other - Last Name:PANDIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:800 WASHINGTON ST
Mailing Address - Street 2:BOX 7105
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1552
Mailing Address - Country:US
Mailing Address - Phone:617-636-7105
Mailing Address - Fax:617-636-1465
Practice Address - Street 1:1 HOAG DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:617-875-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC141135207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease