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NPI Code Detail

MEDICARE: AMEESHA PANDYA KANSUPADA MD

MEDICARE: AMEESHA PANDYA KANSUPADA MD
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
1207R00000XInternal Medicine Physician9600964NC

General Provider Information

NPI Number : 1700895380
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMEESHA PANDYA KANSUPADA MD
Provider Business Mailing Address
First Line : 2001 VAIL AVE
Second Line :
City : CHARLOTTE
State : NC
Zip : 28207-1248
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6115 PARK SOUTH DR STE 100
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3281
Country : US
Telephone Number : 704-554-8787
Fax Number : 704-554-8774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 06/08/2023

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