Provider Demographics
NPI:1720309024
Name:BANDYOPADHYAY, NINA SARA (DO)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:SARA
Last Name:BANDYOPADHYAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:SARA
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1011 REED AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2002
Mailing Address - Country:US
Mailing Address - Phone:610-374-4401
Mailing Address - Fax:610-374-7916
Practice Address - Street 1:1011 REED AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2002
Practice Address - Country:US
Practice Address - Phone:610-374-4401
Practice Address - Fax:610-374-7916
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT013679207R00000X
PAOS018138207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine