Provider Demographics
NPI:1144253121
Name:PAI, PUNDALIK P (MD)
Entity type:Individual
Prefix:
First Name:PUNDALIK
Middle Name:P
Last Name:PAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SOMERSET ST
Mailing Address - Street 2:MILLINOCKET REGIONAL HOSPITAL-INTERNAL MEDICINE
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-1258
Mailing Address - Country:US
Mailing Address - Phone:207-723-5173
Mailing Address - Fax:207-723-3347
Practice Address - Street 1:200 SOMERSET ST
Practice Address - Street 2:MILLINOCKET REGIONAL HOSPITAL-INTERNAL MEDICINE
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-1258
Practice Address - Country:US
Practice Address - Phone:207-723-5173
Practice Address - Fax:207-723-3347
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME007180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5118459OtherAETNA
ME022329OtherANTHEM
2182096OtherFIRST HEALTH
ME022329OtherANTHEM
MEMI200003Medicare ID - Type UnspecifiedGROUP NUMBER
5118459OtherAETNA