1710091855 NPI number — CHARUBEN C PANDYA MD

Table of content: CHARUBEN C PANDYA MD (NPI 1710091855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710091855 NPI number — CHARUBEN C PANDYA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANDYA
Provider First Name:
CHARUBEN
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710091855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6210 US 290
Provider Second Line Business Mailing Address:
SUITE 240
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-231-5506
Provider Business Mailing Address Fax Number:
512-406-6216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 E WHITESTONE BLVD
Provider Second Line Business Practice Location Address:
BLSG C
Provider Business Practice Location Address City Name:
CEDAR PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78613-5028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-259-3467
Provider Business Practice Location Address Fax Number:
512-406-7303
Provider Enumeration Date:
08/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  K8404 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 195890203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 195890201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 195890204 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 195890202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".