Provider Demographics
NPI:1558448928
Name:PATHAK, ANJALI ANIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:ANIL
Last Name:PATHAK
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 1:5251 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-4932
Mailing Address - Country:US
Mailing Address - Phone:904-399-0324
Mailing Address - Fax:904-399-0420
Practice Address - Street 1:5251 EMERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4932
Practice Address - Country:US
Practice Address - Phone:904-399-0324
Practice Address - Fax:904-399-0420
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME623612084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23073OtherBCBS PROVIDER ID NUMBER
FLA61052Medicare UPIN
FLK1420Medicare PIN