MEDICARE: NISHA K PANDIT D.O

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		NY
2	207R00000X	Internal Medicine Physician	34014105	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902251465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NISHA K PANDIT D.O

Provider Business Mailing Address
First Line	:	5455 N MARGINAL RD APT 524
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-3951
Country	:	US
Telephone Number	:	516-209-8431
Fax Number	:

Provider Business Practice Location Address
First Line	:	6990 ENGLE RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3420
Country	:	US
Telephone Number	:	440-202-4200
Fax Number	:

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

Provider Enumeration Date	:	05/03/2016
Last Update Date	:	08/20/2019

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Directions to “ NISHA K PANDIT D.O” Practice Location

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