Provider Demographics
NPI:1194743716
Name:PANDIT, SANDEEP RAJ (M D)
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:RAJ
Last Name:PANDIT
Suffix:
Gender:
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:516 S VAN BUREN RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5019
Practice Address - Country:US
Practice Address - Phone:336-623-9713
Practice Address - Fax:336-623-1031
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55348207RH0003X
VA0101261655207RH0003X
NC200401108207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC138PVOtherBLUE CROSS BLUE SHIELD
NC805471OtherPARTNERS
NC89138PVMedicaid
TN103I835340Medicare PIN
NC89138PVMedicaid
NC2032984Medicare PIN
VAVVN370B288Medicare PIN