Healthcare Provider Details

I. General information

NPI: 1679159636
Provider Name (Legal Business Name): ANIKET PANDYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

84 BENNINGTON ST
HAVERHILL MA
01832-2508
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-7693
  • Fax:
Mailing address:
  • Phone: 978-873-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number1019581
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: