Provider Demographics
NPI:1184848822
Name:PANIGRAHI, DEV D (MD)
Entity Type:Individual
Prefix:
First Name:DEV
Middle Name:D
Last Name:PANIGRAHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 PONDFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708
Mailing Address - Country:US
Mailing Address - Phone:914-337-8797
Mailing Address - Fax:914-337-8881
Practice Address - Street 1:77 PONDFIELD RD
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708
Practice Address - Country:US
Practice Address - Phone:914-337-8797
Practice Address - Fax:914-337-8881
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140078174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00715513Medicaid
NYC06378Medicare UPIN
NY00715513Medicaid