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General NPI Number Information
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NPI Number | 1366641540
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Entity Type | Organization
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Legal Business Name | PANDYA INTERNAL MEDICINE CLINIC, LLC
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 603 S PINE ST
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City | DERIDDER
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State | LA
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Zip | 70634-4941
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Country | US
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Telephone | 337-463-2172
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Fax | 337-462-3243
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Provider Business Mailing Address
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Address Line | 603 S PINE ST
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City | DERIDDER
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State | LA
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Zip | 70634-4941
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Country | US
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Telephone | 337-463-2172
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Fax | 337-462-3243
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MAHESH PANDYA
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Credential | M.D.
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Telephone | 337-463-2172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 05773R
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License Number State | LA
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