PURUSHOTTAM V PANDE (NPI# 1619953072) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619953072 |
| Entity Type | Individual |
| Full Name | PURUSHOTTAM V PANDE |
| Credential | MD |
| Practice Address |
1340 Broad Ave Suite 270 Gulfport MS 39501-2404 |
| Mailing Address |
Po Box 1810 Gulfport MS 39502-1810 |
| Practice Telephone | 2285751234 |
| Practice Fax Number | 2285751240 |
| Mailing Telephone | 2285751234 |
| Mailing Fax Number | 2285751240 |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2014-07-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
11683 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00013335 | 05 |
| Street Address |
1340 BROAD AVE SUITE 270 |
| City | GULFPORT |
| State | MS |
| Zip Code | 39501-2404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912904590 | Jesse Pullen Penico | Internal Medicine | 1340 Broad Ave, Suite 300, Gulfport, MS 39501-2404 | 2005-06-28 |
| 1306409040 | Lissa Kelly Baber | Nurse Practitioner | 1340 Broad Ave, Gulfport, MS 39501-2404 | 2019-04-18 |
| 1780191577 | Tbd Acquisition II LLC | Social Worker | 1340 Broad Ave, Gulfport, MS 39501-2404 | 2018-01-03 |
| 1629517115 | Delana Mooney | Nurse Practitioner | 1340 Broad Ave, Suite 450, Gulfport, MS 39501-2404 | 2017-02-16 |
| 1396299590 | Charles Strange | Nurse Practitioner | 1340 Broad Ave, Suite 450, Gulfport, MS 39501-2404 | 2016-08-05 |
| 1942699988 | Beth Ann Gruzinskas | Nurse Practitioner | 1340 Broad Ave, Suite 270, Gulfport, MS 39501-2404 | 2015-01-14 |
| 1720477714 | Lacey Grimes Lichtenstein | Nurse Practitioner | 1340 Broad Ave, Gulfport, MS 39501-2404 | 2015-01-14 |
| 1669872974 | Jamie B Varnado | Social Worker | 1340 Broad Ave, Ste 410, Gulfport, MS 39501-2404 | 2014-08-25 |
| 1700121209 | Danielle Ronquille Lipski | Occupational Therapist | 1340 Broad Ave, Suite 270, Gulfport, MS 39501-2404 | 2012-12-10 |
| 1164767778 | Shannon Ann Church | Social Worker | 1340 Broad Ave, Ste 410, Gulfport, MS 39501-2404 | 2012-12-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301632 | Daniel Edward Bloom | Physician Assistant | Naval Branch Health Clinic Gulfport, 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2019-11-25 |
| 1730721374 | Affinity Healthcare LLC | Non-emergency Medical Transport (VAN) | 1822 15th St, Suite 8, Gulfport, MS 39501 | 2019-10-15 |
| 1093361156 | Gulf Coast Companion Care, LLC | Home Health | 1314 Pass Road, Ste B, Gulfport, MS 39501 | 2019-08-14 |
| 1609420991 | Greg Meekin Ent | Otolaryngology | 1201 31st Avenue, Gulfport, MS 39501 | 2019-07-25 |
| 1225681216 | Murphy Chiropractic Gulfport, LLC | Clinic/Center | 2700 25th Ave., Gulfport, MS 39501 | 2019-07-19 |
| 1477022838 | Patriot Healthcare of Mississippi, LLC | Family Medicine | 1110 Broad Street, Suite 300, Gulfport, MS 39501 | 2018-11-15 |
| 1477003028 | Mindful Matters | Nurse Practitioner | 1613 23rd Avenue, Gulfport, MS 39501 | 2016-10-06 |
| 1902294093 | Tangular Barnes | Nurse Practitioner | Gulf Coast Mental Health Center, 1600 Broad Ave, Gulfport, MS 39501 | 2014-12-25 |
| 1487065355 | Huong Nguyen | Pharmacist | 2433 25th Avenue, Gulfport, MS 39501 | 2014-05-14 |
| 1770907412 | Matthew Coleman | Military Health Care Provider | Nbhc Naval Construction Battalion Center Gulfport, 5501 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-02-18 |
| Find all providers in zip 39501 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215928478 | Jeffrey L. Paonessa | Internal Medicine | 6112 Kipps Colony Dr W, Gulfport, FL 33707-3970 | 2005-11-04 |
| 1962684555 | Pamela Tuli | Internal Medicine | 1340 Broad Ave, Suite 270, Gulfport, MS 39501-2404 | 2007-12-05 |
| 1346446671 | Allison Paulk Wall | Internal Medicine | 1340 Broad Ave, Suite 270, Gulfport, MS 39501-2404 | 2007-06-24 |
| 1073569018 | Stephanie Fussell | Internal Medicine | 1340 Broad Ave, Suite 270, Gulfport, MS 39501-2404 | 2006-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710365630 | Grenada Hematology Oncology LLC | Internal Medicine | 1300 Sunset Dr Ste F, Grenada, MS 38901-4083 | 2015-05-12 |
| 1720241201 | Jennifer T Eubanks | Internal Medicine | 1704 23rd Ave Fl 2, Meridian, MS 39301-3103 | 2008-07-06 |
| 1780713966 | Jackson Oncology Associates, Pllc | Internal Medicine | 1860 Chadwick Dr Ste 301, Jackson, MS 39204-3467 | 2007-03-05 |
| 1346379500 | Jackson Oncology Associates,pllc | Internal Medicine | 2969 Curran Dr N Ste 200, Jackson, MS 39216-4121 | 2007-03-05 |
| 1023147204 | Jackson Oncology Associates, Pllc | Internal Medicine | 2200 Highway 61 N Ste 3300, Vicksburg, MS 39183-8246 | 2007-03-05 |
| 1760585178 | Rose Cancer Center PC | Internal Medicine | 807 Robb Street, Summit, MS 39666 | 2006-09-07 |
| 1215960786 | Wail Alnas | Internal Medicine | 345 Baptist Blvd, Columbus, MS 39705 | 2006-07-08 |
| 1760415608 | Benton M Wheeler | Internal Medicine | 504 Azalea Dr Ste A, Oxford, MS 38655-5397 | 2006-07-07 |
| 1801825781 | Sonia M Benn | Internal Medicine | 7668 Airways Blvd, Southaven, MS 38671-5304 | 2006-07-02 |
| 1639119589 | Justin T Baker | Internal Medicine | 1227 N State St Ste 101, Jackson, MS 39202-2002 | 2006-06-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.