Healthcare Provider Details

I. General information

NPI: 1710944251
Provider Name (Legal Business Name): NITHIYANANDHI PANDIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 04/26/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DALLAS VA MEDICAL CENTER 4500 SOUTH LANCASTER ROAD
DALLAS TX
75216-7521
US

IV. Provider business mailing address

3120 SAN SEBASTIAN DR
CARROLLTON TX
75006-5208
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-2742
  • Fax:
Mailing address:
  • Phone: 254-717-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN2229
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: