Provider Demographics
NPI:1538112586
Name:PANNA, MARK EDWARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:PANNA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-273-9079
Mailing Address - Fax:352-273-8889
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:DIVISION OF CARDIOLOGY, 4TH FLOOR
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-9079
Practice Address - Fax:352-273-8889
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME103664207RC0001X, 207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101366697Medicaid
FL002587700Medicaid
PAI 37867Medicare UPIN
PA101366697Medicaid
FL002587700Medicaid