Provider Demographics
NPI:1609937267
Name:PANWALKER, ANAND P (MD)
Entity Type:Individual
Prefix:MR
First Name:ANAND
Middle Name:P
Last Name:PANWALKER
Suffix:
Gender:M
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:C78 80 OMEGA DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-368-2883
Mailing Address - Fax:302-368-2892
Practice Address - Street 1:C78 80 OMEGA DRIVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-368-2883
Practice Address - Fax:302-368-2892
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002557207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000022199Medicaid
DE011309I75Medicare ID - Type UnspecifiedMEDICARE
DE011309I75Medicare PIN
DEC45321Medicare UPIN