Provider Demographics
NPI:1497011316
Name:PANDYA, TEJAL GAURANG (MD)
Entity type:Individual
Prefix:
First Name:TEJAL
Middle Name:GAURANG
Last Name:PANDYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3286
Mailing Address - Country:US
Mailing Address - Phone:559-782-8533
Mailing Address - Fax:559-782-8544
Practice Address - Street 1:555 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3286
Practice Address - Country:US
Practice Address - Phone:559-782-8533
Practice Address - Fax:559-782-8544
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128754208600000X, 208600000X
WAMD61157645208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1497011316Medicaid