Provider Demographics
NPI:1760455612
Name:PANESAR, NARENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:NARENDRA
Middle Name:
Last Name:PANESAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-763-6285
Mailing Address - Fax:607-763-5410
Practice Address - Street 1:33-57 HARRISON ST
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2107
Practice Address - Country:US
Practice Address - Phone:607-763-6285
Practice Address - Fax:607-763-5410
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179258174400000X
NY178014207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY824081OtherBLUE CROSS PROVIDER#
NYF44467Medicare UPIN
NY824081OtherBLUE CROSS PROVIDER#