Provider Demographics
NPI:1205817095
Name:PANICO, JOHN LOCHIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LOCHIEL
Last Name:PANICO
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 1:120 MADISON AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2055
Mailing Address - Country:US
Mailing Address - Phone:609-261-1660
Mailing Address - Fax:609-261-1779
Practice Address - Street 1:175 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2038
Practice Address - Country:US
Practice Address - Phone:609-267-0700
Practice Address - Fax:609-261-4801
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECI0005742207L00000X
NJ25MA07548400207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H03749Medicare UPIN
DE0000972601Medicare ID - Type Unspecified
DE490416Medicare ID - Type Unspecified