MEDICARE: PANDYA MEDICAL P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	N1039	TX

General Provider Information

NPI Number	:	1316191141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANDYA MEDICAL P.A.

Provider Business Mailing Address
First Line	:	14080 NACOGDOCHES RD # 313
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1944
Country	:	US
Telephone Number	:	210-281-1701
Fax Number	:

Provider Business Practice Location Address
First Line	:	14080 NACOGDOCHES RD # 313
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1944
Country	:	US
Telephone Number	:	210-281-1701
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MAYANK PANDYA
Credential	:	M.D.
Telephone Number	:	210-281-1701

Provider Enumeration Date	:	11/06/2008
Last Update Date	:	03/15/2011

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