Healthcare Provider Details

I. General information

NPI: 1154987444
Provider Name (Legal Business Name): KAMALDEEP NANDRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MARKET ST
BOARDMAN OH
44512-6725
US

IV. Provider business mailing address

380 SUMMIT AVENUE, MSO PHYSICIAN BILLING
STEUBENVILLE OH
43952-2667
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-4298
  • Fax: 330-729-1591
Mailing address:
  • Phone: 740-283-7597
  • Fax: 740-283-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.146494
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.146494
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: