Basic Information
| Provider Information | |||||||||
| NPI: | 1881675452 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANDEY | ||||||||
| FirstName: | RAVI | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 S AUSTRALIAN AVE | ||||||||
| Address2: | STE 400 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334015018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618058500 | ||||||||
| FaxNumber: | 5618058501 | ||||||||
| Practice Location | |||||||||
| Address1: | 11000 PROSPERITY FARMS RD STE 206 | ||||||||
| Address2: | |||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334103462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616224646 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 02/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | ME71893 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | ME71893 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 32806 | 01 | FL | BCBS | OTHER |