Provider Demographics
NPI:1770763146
Name:PANDYA, YAGNIK KRISHNAKANT (MB,BS)
Entity type:Individual
Prefix:DR
First Name:YAGNIK
Middle Name:KRISHNAKANT
Last Name:PANDYA
Suffix:
Gender:M
Credentials:MB,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 UNION ST 5
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-7700
Mailing Address - Country:US
Mailing Address - Phone:508-650-7725
Mailing Address - Fax:508-650-7769
Practice Address - Street 1:67 UNION ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-650-7725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004028208600000X
MA246550208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03474513Medicaid
MA110104694AMedicaid
J400072861Medicare PIN