Provider Demographics
NPI:1699830604
Name:MIRCHANDANI, PUSHPA P (MD)
Entity Type:Individual
Prefix:DR
First Name:PUSHPA
Middle Name:P
Last Name:MIRCHANDANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2831
Mailing Address - Country:US
Mailing Address - Phone:856-768-9213
Mailing Address - Fax:
Practice Address - Street 1:201 COOPER RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2831
Practice Address - Country:US
Practice Address - Phone:856-768-9213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41549208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics