Provider Demographics
NPI:1881699163
Name:PANDYA, GAURANG S (MD)
Entity type:Individual
Prefix:MR
First Name:GAURANG
Middle Name:S
Last Name:PANDYA
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 1:555 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3286
Mailing Address - Country:US
Mailing Address - Phone:559-782-8533
Mailing Address - Fax:
Practice Address - Street 1:555 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3286
Practice Address - Country:US
Practice Address - Phone:559-782-8533
Practice Address - Fax:559-782-8544
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2016-01-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
CAA44314174400000X
CAA443140208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A443140Medicare PIN
CA00A443140Medicare UPIN