Provider Demographics
NPI:1770564387
Name:PANDORA FAMILY PHYSICIANS, INC.
Entity type:Organization
Organization Name:PANDORA FAMILY PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-384-3251
Mailing Address - Street 1:202 HILTY DRIVE
Mailing Address - Street 2:PO BOX 299
Mailing Address - City:PANDORA
Mailing Address - State:OH
Mailing Address - Zip Code:45877-0299
Mailing Address - Country:US
Mailing Address - Phone:419-384-3251
Mailing Address - Fax:419-384-3269
Practice Address - Street 1:202 HILTY DRIVE
Practice Address - Street 2:
Practice Address - City:PANDORA
Practice Address - State:OH
Practice Address - Zip Code:45877-9703
Practice Address - Country:US
Practice Address - Phone:419-384-3251
Practice Address - Fax:419-384-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0581517Medicaid
OH0581517Medicaid
OH9919771Medicare ID - Type UnspecifiedPANDORA'S LOCATION