Provider Demographics
NPI:1073509998
Name:PANIK, GARY M (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:PANIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:7096 DECATUR ST
Practice Address - Street 2:
Practice Address - City:NEW TRIPOLI
Practice Address - State:PA
Practice Address - Zip Code:18066-3815
Practice Address - Country:US
Practice Address - Phone:610-298-8521
Practice Address - Fax:610-298-3021
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS006044E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010797850002Medicaid
C35220Medicare UPIN
PA0010797850002Medicaid