Provider Demographics
NPI:1952681124
Name:VIRAG PANDEYA, MD PLLC
Entity Type:Organization
Organization Name:VIRAG PANDEYA, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-524-1201
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-0159
Mailing Address - Country:US
Mailing Address - Phone:270-524-1201
Mailing Address - Fax:270-524-1202
Practice Address - Street 1:950 MAIN ST
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-9435
Practice Address - Country:US
Practice Address - Phone:270-524-1201
Practice Address - Fax:270-524-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty