Healthcare Provider Details

I. General information

NPI: 1164618757
Provider Name (Legal Business Name): MAHESH PANDEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DANA FARBER COMMUNITY CANCER CARE 51 PERFORMANCE DRIVE, SUITE 110
WEYMOUTH MA
02189
US

IV. Provider business mailing address

PO BOX 1638
ALBANY NY
12201-1638
US

V. Phone/Fax

Practice location:
  • Phone: 781-682-4066
  • Fax: 781-337-9619
Mailing address:
  • Phone: 207-777-4111
  • Fax: 207-783-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number017535
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number268139
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: