Provider Demographics
NPI:1205866183
Name:PANIGRAHI, DIPAK (MD)
Entity Type:Individual
Prefix:DR
First Name:DIPAK
Middle Name:
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 1:3553 16TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3041
Mailing Address - Country:US
Mailing Address - Phone:202-387-8900
Mailing Address - Fax:202-328-0565
Practice Address - Street 1:3553 16TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3041
Practice Address - Country:US
Practice Address - Phone:202-387-8900
Practice Address - Fax:202-328-0565
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD035638207W00000X
VA0101238649207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I48911Medicare UPIN
018832L71Medicare ID - Type UnspecifiedINDIVIDUAL