Basic Information
| Provider Information | |||||||||
| NPI: | 1396853602 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PANDYA | ||||||||
| FirstName: | MELIND | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 56 | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082100056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094632755 | ||||||||
| FaxNumber: | 6094632757 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082101939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094632755 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 25MB07515600 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 0116629 | 05 | NJ | MEDICAID |