Provider Demographics
NPI:1649218538
Name:PAI, VISHNUDAS PANEMANGLORE (MD)
Entity Type:Individual
Prefix:
First Name:VISHNUDAS
Middle Name:PANEMANGLORE
Last Name:PAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6 WELLNESS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 WELLNESS WAY STE G03
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2156
Practice Address - Country:US
Practice Address - Phone:518-785-5884
Practice Address - Fax:518-783-6890
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238785208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00617034OtherRAILROAD MEDICARE
NY02777195Medicaid
071202000026OtherFIDELIS
10126571OtherCDPHP
6655H1OtherEMPIRE BLUE CROSS
4158774OtherMVP
7578940OtherAETNA
NYRB4659Medicare PIN