Healthcare Provider Details

I. General information

NPI: 1225179138
Provider Name (Legal Business Name): VIDYA N BHANDARKAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E. EL CAMINO REAL
MOUNTAIN VIEW CA
94040-2833
US

IV. Provider business mailing address

2350 W. EL CAMINO REAL 2ND FLOOOR
MOUNTAIN VIEW CA
94040-6203
US

V. Phone/Fax

Practice location:
  • Phone: 650-934-7800
  • Fax:
Mailing address:
  • Phone: 831-385-5471
  • Fax: 831-385-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24984
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA105877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: