Basic Information
| Provider Information | |||||||||
| NPI: | 1720309024 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANDYOPADHYAY | ||||||||
| FirstName: | NINA | ||||||||
| MiddleName: | SARA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GEORGE | ||||||||
| OtherFirstName: | NINA | ||||||||
| OtherMiddleName: | SARA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1011 REED AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196102002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103744401 | ||||||||
| FaxNumber: | 6103747916 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 REED AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196102002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103744401 | ||||||||
| FaxNumber: | 6103747916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2010 | ||||||||
| LastUpdateDate: | 04/27/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OT013679 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | OS018138 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.