Healthcare Provider Details

I. General information

NPI: 1477509214
Provider Name (Legal Business Name): KESHAV PANDEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WINTHROP ST
WORCESTER MA
01604-4435
US

IV. Provider business mailing address

10 WINTHROP ST
WORCESTER MA
01604-4435
US

V. Phone/Fax

Practice location:
  • Phone: 508-755-7794
  • Fax: 508-755-7070
Mailing address:
  • Phone: 508-755-7794
  • Fax: 508-755-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number37367
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2045192
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
Identifier207RG0100X
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTAXOMONY NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: