MEDICARE: RAMESH C TANDON MD PLLC

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1508110032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAMESH C TANDON MD PLLC

Provider Business Mailing Address
First Line	:	PO BOX 10889
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86427-0889
Country	:	US
Telephone Number	:	928-788-4944
Fax Number	:	928-788-3900

Provider Business Practice Location Address
First Line	:	1520 E HAMMER LN
Second Line	:	SUITE 105
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6664
Country	:	US
Telephone Number	:	928-788-4944
Fax Number	:	928-788-3900

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	RAMESH C TANDON
Credential	:	MD
Telephone Number	:	928-788-4944

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	11/06/2012

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