MEDICARE: AMBARISH PANDEY M.D

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RC0000X	Cardiovascular Disease Physician	R2434	TX

General Provider Information

NPI Number	:	1891084729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBARISH PANDEY M.D

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5939 HARRY HINES BLVD 9TH FL STE 935
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7708
Country	:	US
Telephone Number	:	214-645-8000
Fax Number	:

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

Provider Enumeration Date	:	03/31/2011
Last Update Date	:	05/02/2019

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