Provider Demographics
NPI:1679984884
Name:PANNAPARA, JOSEPH JOHANNAN
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JOHANNAN
Last Name:PANNAPARA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:PANNAPARA
Other - Middle Name:JOSEPH
Other - Last Name:JOHANNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 N PENN ST UNIT P1805
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3142
Mailing Address - Country:US
Mailing Address - Phone:215-300-7393
Mailing Address - Fax:
Practice Address - Street 1:111 S 11TH ST # 8490
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-6161
Practice Address - Fax:215-923-5507
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14443900367500000X
DEL1-0039648367500000X
PARN563132367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered