Provider Demographics
NPI:1033106745
Name:PANGARKAR, SANDEEP SHARAD (DO)
Entity type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:SHARAD
Last Name:PANGARKAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-5015
Mailing Address - Fax:208-381-1873
Practice Address - Street 1:190 E BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6241
Practice Address - Country:US
Practice Address - Phone:208-381-6474
Practice Address - Fax:208-381-1873
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8062207R00000X, 208M00000X
NC200201615208M00000X
IDO1027208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX328526402Medicaid
TX328526401Medicaid
TX328526404Medicaid
NC89133FPMedicaid
SCN01619Medicaid
TX328526405Medicaid
TX326881YLP2Medicare PIN
NC89133FPMedicaid
TX328526405Medicaid
H72212Medicare UPIN
TX328526401Medicaid
TX326881YLP1Medicare PIN
TX326881YKXYMedicare PIN
TX326881YKXVMedicare PIN
NC2011837BMedicare ID - Type UnspecifiedCHG