Provider Demographics
NPI:1457373326
Name:PANDIT, ASHWINI WAGHOLIKAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHWINI
Middle Name:WAGHOLIKAR
Last Name:PANDIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ASHWINI
Other - Middle Name:RAJU
Other - Last Name:CHAVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5301 VIRGINIA WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7542
Mailing Address - Country:US
Mailing Address - Phone:615-695-4977
Mailing Address - Fax:615-263-3348
Practice Address - Street 1:5301 VIRGINIA WAY STE 300
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7542
Practice Address - Country:US
Practice Address - Phone:615-695-4977
Practice Address - Fax:615-263-3348
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44560207ZP0105X
IN01064993A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000569161OtherANTHEM BCBS OF IN
INM400061894OtherMEDICARE
WI34208600Medicaid
IN200901720Medicaid
WI0113 73-601Medicare ID - Type UnspecifiedMILWAUKEE COUNTY
H63063Medicare UPIN
ILR01223Medicare PIN
IN000000569161OtherANTHEM BCBS OF IN
IN255020IMedicare PIN