Healthcare Provider Details

I. General information

NPI: 1871552950
Provider Name (Legal Business Name): ATMARAM S PAI PANANDIKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 SUMMERS RIDGE RD
SAN DIEGO CA
92121-3101
US

IV. Provider business mailing address

354 N WILLETT ST
MEMPHIS TN
38112-5120
US

V. Phone/Fax

Practice location:
  • Phone: 503-989-3483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number0101236519
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01094918A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberC130278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: