Provider Demographics
NPI:1982887212
Name:GOYLE, VANDANA PANDA (MD)
Entity Type:Individual
Prefix:
First Name:VANDANA
Middle Name:PANDA
Last Name:GOYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 RAINTREE CIR STE 120
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5257
Mailing Address - Country:US
Mailing Address - Phone:972-747-0777
Mailing Address - Fax:214-383-4559
Practice Address - Street 1:1120 RAINTREE CIR STE 120
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5257
Practice Address - Country:US
Practice Address - Phone:972-747-0777
Practice Address - Fax:214-383-4559
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine