Provider Demographics
NPI:1437131786
Name:PANICKER, USHA R (MD)
Entity Type:Individual
Prefix:DR
First Name:USHA
Middle Name:R
Last Name:PANICKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2551
Mailing Address - Country:US
Mailing Address - Phone:732-744-9288
Mailing Address - Fax:
Practice Address - Street 1:2 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2551
Practice Address - Country:US
Practice Address - Phone:732-744-9288
Practice Address - Fax:732-744-9278
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05249000207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4526619OtherAETNA
NJ1K6836OtherHEALTHNET
NJ5364906Medicaid
NJ1121995OtherHORIZON NJ HEALTH
NJLP195OtherOXFORD
NJ1121995OtherHORIZON NJ HEALTH
NJ4526619OtherAETNA