MEDICARE: KAUSHIK PANDYA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	020871	PA

General Provider Information

NPI Number	:	1184891988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAUSHIK PANDYA

Provider Business Mailing Address
First Line	:	2627 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-1618
Country	:	US
Telephone Number	:	215-228-8723
Fax Number	:

Provider Business Practice Location Address
First Line	:	2627 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-1618
Country	:	US
Telephone Number	:	215-228-8723
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	11/14/2011

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Directions to “ KAUSHIK PANDYA ” Practice Location

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