Provider Demographics
NPI:1982672341
Name:PANIKKAR, ANANDA KRISHNAN (MD)
Entity Type:Individual
Prefix:
First Name:ANANDA
Middle Name:KRISHNAN
Last Name:PANIKKAR
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 1:38 MILLERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-7103
Mailing Address - Country:US
Mailing Address - Phone:570-784-6118
Mailing Address - Fax:570-784-7046
Practice Address - Street 1:549 E. FAIR ST.
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815
Practice Address - Country:US
Practice Address - Phone:570-784-6118
Practice Address - Fax:570-784-7046
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038207L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008034090004Medicaid
093891Medicare ID - Type Unspecified