Provider Demographics
NPI:1518022920
Name:PANICCIA, GREGORY SEAN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:SEAN
Last Name:PANICCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1908 SWEETWATER RD
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7628
Mailing Address - Country:US
Mailing Address - Phone:619-327-0155
Mailing Address - Fax:619-327-0163
Practice Address - Street 1:1908 SWEETWATER RD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7628
Practice Address - Country:US
Practice Address - Phone:619-327-0155
Practice Address - Fax:619-327-0163
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG769792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG76979Medicare UPIN
CAF81984Medicare UPIN