Provider Demographics
NPI:1881791564
Name:GANDHI, NIRAV S (MD)
Entity type:Individual
Prefix:
First Name:NIRAV
Middle Name:S
Last Name:GANDHI
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:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-724-8777
Mailing Address - Fax:702-724-8749
Practice Address - Street 1:2610 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2869
Practice Address - Country:US
Practice Address - Phone:702-724-8777
Practice Address - Fax:702-724-8749
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12019207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVEM831ZMedicare PIN
NV102807Medicare PIN
NVV113998Medicare PIN