Provider Demographics
NPI:1346301801
Name:PANIS, ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:PANIS
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 1:2352 PHILMONT AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6228
Mailing Address - Country:US
Mailing Address - Phone:215-947-4574
Mailing Address - Fax:215-947-0904
Practice Address - Street 1:2352 PHILMONT AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6228
Practice Address - Country:US
Practice Address - Phone:215-947-4574
Practice Address - Fax:215-947-0904
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039917E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1159035Medicaid
PAE12878Medicare UPIN
109493Medicare ID - Type Unspecified
PA670115Medicare PIN