Provider Demographics
NPI:1942464680
Name:PANETTA, NICHOLAS LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:LOUIS
Last Name:PANETTA
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 1:100 E LANCASTER AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3451
Mailing Address - Country:US
Mailing Address - Phone:610-642-3796
Mailing Address - Fax:610-642-2943
Practice Address - Street 1:100 E LANCASTER AVE STE 230
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3451
Practice Address - Country:US
Practice Address - Phone:610-642-3796
Practice Address - Fax:610-642-2943
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432897207R00000X, 207RP1001X, 207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007278000OtherMEDICAID TPI GROUP
PACD4829OtherRAILROAD MEDICARE TPI GROUP
PA597586OtherMEDICARE TPI GROUP