Provider Demographics
NPI:1821080920
Name:PANDIT, VIDYA (MD)
Entity Type:Individual
Prefix:
First Name:VIDYA
Middle Name:
Last Name:PANDIT
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 1:5255 N ABBE RD
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1451
Mailing Address - Country:US
Mailing Address - Phone:440-617-1823
Mailing Address - Fax:440-617-0884
Practice Address - Street 1:32730 WALKER RD
Practice Address - Street 2:BUILDING H
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-4100
Practice Address - Country:US
Practice Address - Phone:440-930-4955
Practice Address - Fax:440-930-4960
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110223810OtherRR MEDICARE
OH2236226Medicaid
OH110223810OtherRR MEDICARE
OH4091421Medicare PIN
OHH32849Medicare UPIN
OH2236226Medicaid