Provider Demographics
NPI:1740274133
Name:PANDEY, ANAND (MD)
Entity type:Individual
Prefix:
First Name:ANAND
Middle Name:
Last Name:PANDEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 HARKEY LANE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406
Mailing Address - Country:US
Mailing Address - Phone:205-344-6344
Mailing Address - Fax:205-344-6464
Practice Address - Street 1:4810 HARKEY LANE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406
Practice Address - Country:US
Practice Address - Phone:205-344-6344
Practice Address - Fax:205-344-6464
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20271207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000032764Medicaid
209445OtherFEDERAL BLACK LUNG PROGRA
MS09015593Medicaid
AL51032764OtherBC/BS OF ALABAMA
MS09015593Medicaid
209445OtherFEDERAL BLACK LUNG PROGRA
AL000032764Medicaid