Individual
DR. MANISH PANDYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 S LAKE ST STE B, FARMINGTON, NM 87401
(505) 278-8575
(505) 787-2399
Mailing address
PO BOX 6210, FARMINGTON, NM 87499-6210
(505) 609-2258
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
72-43923-1205
UT
207RN0300X
Nephrology Physician
Primary
MD-2005-0152
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04056558
—
CO
05
—
109497
—
AZ
05
—
1326145392
—
UT
05
—
33633339
—
NM
Enumeration date
09/20/2006
Last updated
07/29/2024
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