Provider Demographics
NPI:1144226051
Name:PANELLI, FERDINAND (MD, MS, FACP)
Entity Type:Individual
Prefix:
First Name:FERDINAND
Middle Name:
Last Name:PANELLI
Suffix:
Gender:M
Credentials:MD, MS, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800727
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0727
Mailing Address - Country:US
Mailing Address - Phone:787-848-7770
Mailing Address - Fax:787-848-5818
Practice Address - Street 1:909 AVE TITO CASTRO STE 612
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4722
Practice Address - Country:US
Practice Address - Phone:787-848-7770
Practice Address - Fax:787-848-5818
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8646207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80324OtherTRIPLE S
PR600681OtherMEDICARE Y MUCHO MAS
PR067865OtherCRUZ AZUL
PR314OtherAMERICAN HEALTH MEDICARE
PR9155OtherFIRST MEDICAL
PR7320029OtherHUMANA
PR7320029OtherHUMANA
PR067865OtherCRUZ AZUL