Provider Demographics
NPI:1689605214
Name:PASTERNAK, ANDREW V IV (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:V
Last Name:PASTERNAK
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10467 DOUBLE R BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8905
Mailing Address - Country:US
Mailing Address - Phone:775-853-9394
Mailing Address - Fax:775-853-3339
Practice Address - Street 1:10467 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8905
Practice Address - Country:US
Practice Address - Phone:775-853-9394
Practice Address - Fax:775-853-3339
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV8674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016285Medicaid
NVF93853Medicare UPIN
NV102223Medicare ID - Type Unspecified