Provider Demographics
NPI:1528038403
Name:PANITCH, KENNETH NOAH (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:NOAH
Last Name:PANITCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:132 GROVE ST
Practice Address - Street 2:SUITE A
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1224
Practice Address - Country:US
Practice Address - Phone:856-354-2211
Practice Address - Fax:856-354-6181
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2010-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06167300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356 SK3Medicare PIN