Provider Demographics
NPI:1619924370
Name:PANI, SIDHARTHA (MD)
Entity Type:Individual
Prefix:
First Name:SIDHARTHA
Middle Name:
Last Name:PANI
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1222 JEFFERSON PARK AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-3410
Practice Address - Country:US
Practice Address - Phone:434-982-3040
Practice Address - Fax:434-245-3535
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202636207R00000X
VA0101230906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2959888-002OtherCIGNAPAL
MA409720OtherBCBSRI BLUE CHIP
MA97384602OtherNETWORKHEALTH
MA0169960Medicaid
MA2959888OtherCIGNA
MA456086OtherTUFTS HEALTH PLAN
MA0028365OtherNEIGHBORHOD HEALTH PLAN
MA29421-0OtherBCBSRI
MA3756469OtherAETNA
MAAA31394OtherHARVARD PILGRIM
MA000000029129OtherBMC HEALTHNET
MA004450OtherSENIORWHOLEHEALTH
MAJ24451OtherBCBSMA
MA042675800OtherUNITED HEALTH
MAAA31394OtherHARVARD PILGRIM
MA2959888OtherCIGNA