Provider Demographics
NPI:1255441747
Name:PANDYA, RAJIV D (MD)
Entity type:Individual
Prefix:
First Name:RAJIV
Middle Name:D
Last Name:PANDYA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1035 SOUTHCREST DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6118
Mailing Address - Country:US
Mailing Address - Phone:770-389-9005
Mailing Address - Fax:770-389-5251
Practice Address - Street 1:1035 SOUTHCREST DR
Practice Address - Street 2:SUITE 100
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6118
Practice Address - Country:US
Practice Address - Phone:770-389-9005
Practice Address - Fax:770-389-5251
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-06-30
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Provider Licenses
StateLicense IDTaxonomies
GA033254207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF34032Medicare UPIN
GA20BDBXSMedicare PIN