Healthcare Provider Details

I. General information

NPI: 1992125272
Provider Name (Legal Business Name): VIRAJ PANDIT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 E HERNDON AVE STE 201
FRESNO CA
93720-2989
US

IV. Provider business mailing address

1802 E 19TH ST
TULSA OK
74104-5403
US

V. Phone/Fax

Practice location:
  • Phone: 559-228-6600
  • Fax:
Mailing address:
  • Phone: 918-634-7543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberC195796
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number34817
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34817
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: