Provider Demographics
NPI:1306863055
Name:PANT DHODAPKAR, ANUPAMA (MD)
Entity Type:Individual
Prefix:
First Name:ANUPAMA
Middle Name:
Last Name:PANT DHODAPKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANUPAMA
Other - Middle Name:BASANT
Other - Last Name:PANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100B MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5674
Mailing Address - Country:US
Mailing Address - Phone:979-297-6401
Mailing Address - Fax:979-297-6809
Practice Address - Street 1:100B MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5674
Practice Address - Country:US
Practice Address - Phone:979-297-6401
Practice Address - Fax:979-297-6809
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9841207RH0003X
TXL-9841207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Not Answered207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG-63907Medicare UPIN
TX8D3765Medicare ID - Type Unspecified