Healthcare Provider Details

I. General information

NPI: 1134235393
Provider Name (Legal Business Name): PANKAJ TIWARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 CHERRY WAY DR STE 700
GAHANNA OH
43230-6799
US

IV. Provider business mailing address

1329 CHERRY WAY DR STE 200
GAHANNA OH
43230-6781
US

V. Phone/Fax

Practice location:
  • Phone: 855-687-6227
  • Fax: 855-687-6227
Mailing address:
  • Phone: 614-202-7468
  • Fax: 855-687-6227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35089337
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: