Provider Demographics
NPI:1134235393
Name:TIWARI, PANKAJ (MD)
Entity type:Individual
Prefix:DR
First Name:PANKAJ
Middle Name:
Last Name:TIWARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1329 CHERRY WAY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6781
Mailing Address - Country:US
Mailing Address - Phone:614-202-7468
Mailing Address - Fax:855-687-6227
Practice Address - Street 1:1329 CHERRY WAY DR STE 700
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6799
Practice Address - Country:US
Practice Address - Phone:855-687-6227
Practice Address - Fax:855-687-6227
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089337208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTI4213121Medicare PIN
OH2769848Medicaid