Provider Demographics
NPI:1689611691
Name:GANDHI, PARAG DINESH (MD)
Entity Type:Individual
Prefix:DR
First Name:PARAG
Middle Name:DINESH
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9110 PHILADELPHIA RD
Mailing Address - Street 2:STE 108
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4323
Mailing Address - Country:US
Mailing Address - Phone:410-517-7957
Mailing Address - Fax:833-944-1871
Practice Address - Street 1:9110 PHILADELPHIA RD
Practice Address - Street 2:STE 108
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4323
Practice Address - Country:US
Practice Address - Phone:410-517-7957
Practice Address - Fax:833-944-1871
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0084895207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4109940OtherBCBS OF TN PROVIDER ID#
NC143PCOtherBCBS
TN3893451Medicare ID - Type Unspecified
NC2059806Medicare PIN
TN4109940OtherBCBS OF TN PROVIDER ID#