Healthcare Provider Details

I. General information

NPI: 1275535403
Provider Name (Legal Business Name): HEMANT K PANDEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 W CHANDLER BLVD BLDG F
CHANDLER AZ
85226-3732
US

IV. Provider business mailing address

4045 W CHANDLER BLVD BLDG F
CHANDLER AZ
85226-3732
US

V. Phone/Fax

Practice location:
  • Phone: 480-917-3706
  • Fax: 480-353-2066
Mailing address:
  • Phone: 480-917-3706
  • Fax: 480-353-2066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number42025
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number42025
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number42025
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: