=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457373326
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHWINI WAGHOLIKAR PANDIT MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5301 VIRGINIA WAY STE 300
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-7542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-695-4977
-----------------------------------------------------
Fax | 615-263-3348
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5301 VIRGINIA WAY STE 300
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-7542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-695-4977
-----------------------------------------------------
Fax | 615-263-3348
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0105X
-----------------------------------------------------
Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
-----------------------------------------------------
License Number | 44560
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 01064993A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------