Provider Demographics
NPI:1962661686
Name:PANOV, FEDOR E (MD)
Entity Type:Individual
Prefix:MR
First Name:FEDOR
Middle Name:E
Last Name:PANOV
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 1:1249 PARK AVE APT 10G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-7220
Mailing Address - Country:US
Mailing Address - Phone:570-578-6634
Mailing Address - Fax:
Practice Address - Street 1:1249 PARK AVE APT 10G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7220
Practice Address - Country:US
Practice Address - Phone:570-578-6634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAM970780539892207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery