Provider Demographics
NPI:1750474524
Name:PANICHELLA, THOMAS FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FRANCIS
Last Name:PANICHELLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:124 MAIN ST
Mailing Address - Street 2:STE 9
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-271-7136
Mailing Address - Fax:631-271-0533
Practice Address - Street 1:124 MAIN ST
Practice Address - Street 2:STE 9
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-271-7136
Practice Address - Fax:631-271-0533
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
NY194859207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY194859OtherWORKERS' COMPENSATION
NYBP4609686OtherDEA
NYBP4609686OtherDEA
G02780Medicare UPIN