Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DEN03178 | RI |
N | 1223G0001X | General Practice | 12544 | CT |
N | 213EG0000X | General Practice | 12544 | CT |
N | 1223G0001X | General Practice | 21146 | MA |
N | 213EG0000X | General Practice | 21146 | MA |
NPI | 1215044458 |
---|---|
Provider Name | Dr. Raj Pande |
First Address | West Warwick, RI 02893-4834 |
Second Address | West Warwick, RI 02893-4834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 12/06/2019 |