MEDICARE: ATMARAM S PAI PANANDIKER 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
1	2085R0001X	Radiation Oncology Physician	0101236519	VA
2	2085R0001X	Radiation Oncology Physician	01094918A	IN
3	2085R0001X	Radiation Oncology Physician	C130278	CA

General Provider Information

NPI Number	:	1871552950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATMARAM S PAI PANANDIKER MD

Provider Business Mailing Address
First Line	:	354 N WILLETT ST
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-5120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9730 SUMMERS RIDGE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3101
Country	:	US
Telephone Number	:	503-989-3483
Fax Number	:

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	11/15/2024

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