Provider Demographics
NPI:1609802388
Name:PANOOR, LEELA (MD)
Entity Type:Individual
Prefix:
First Name:LEELA
Middle Name:
Last Name:PANOOR
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 1:155 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3578
Mailing Address - Country:US
Mailing Address - Phone:860-872-9825
Mailing Address - Fax:860-870-9384
Practice Address - Street 1:155 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3578
Practice Address - Country:US
Practice Address - Phone:860-872-9825
Practice Address - Fax:860-870-9384
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024173101Y00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001241736Medicaid
CT001241736Medicaid