Provider Demographics
NPI:1629658505
Name:PANNELL, JOSHUA TYLER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:TYLER
Last Name:PANNELL
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 1:20 OGIER ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-6011
Mailing Address - Country:US
Mailing Address - Phone:803-468-4044
Mailing Address - Fax:
Practice Address - Street 1:20 OGIER ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-6011
Practice Address - Country:US
Practice Address - Phone:803-468-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program