Provider Demographics
NPI:1710944251
Name:PANDIAN, NITHIYANANDHI (MD)
Entity Type:Individual
Prefix:
First Name:NITHIYANANDHI
Middle Name:
Last Name:PANDIAN
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 1:3120 SAN SEBASTIAN DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-5208
Mailing Address - Country:US
Mailing Address - Phone:254-717-1920
Mailing Address - Fax:
Practice Address - Street 1:DALLAS VA MEDICAL CENTER
Practice Address - Street 2:4500 SOUTH LANCASTER ROAD
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7521
Practice Address - Country:US
Practice Address - Phone:214-857-2742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN2229OtherTEXAS MEDICAL LICENSE
CT110009545Medicare ID - Type Unspecified