Provider Demographics
NPI:1467488106
Name:PANIGRAHI, GUNADHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:GUNADHAR
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 1:205 BUSINESS PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6335
Mailing Address - Country:US
Mailing Address - Phone:757-962-1083
Mailing Address - Fax:757-962-1254
Practice Address - Street 1:1925 GLENN MITCHELL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0170
Practice Address - Country:US
Practice Address - Phone:757-507-0702
Practice Address - Fax:757-962-1254
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035440207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA269854OtherANTHEM
VAPAROtherVIRGINIA HEALTH NETWORK
VA-001OtherTRICARE/CHAMPUS
VA10015734OtherSENTARA OPTIMA
VA12375OtherOPTIMA HEALTH PLAN
VAPAROtherAETNA
VAPAROtherUSA MANAGED CARE
VA010226589Medicaid
VAPAROtherCIGNA
VAPAROtherMULTIPLAN
NC06381OtherBC/BS
VA1467488106Medicaid
VA187094OtherANTHEM BC/BS
413774OtherUHC/MAMSI
NC8906381Medicaid
VA313774OtherMAMSI
VAPAROtherCORVEL/CORCARE
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VAPAROtherVIRGINIA PREMIER HEALTH
NC8906381Medicaid
VA009169C00Medicare PIN
VAP00445568Medicare PIN
NC06381OtherBC/BS
413774OtherUHC/MAMSI