Provider Demographics
NPI:1255399432
Name:PANIKAR, MINI ABRAHAM (MD)
Entity type:Individual
Prefix:
First Name:MINI
Middle Name:ABRAHAM
Last Name:PANIKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:515 FAIRMOUNT AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8518
Mailing Address - Country:US
Mailing Address - Phone:410-526-3017
Mailing Address - Fax:410-584-1888
Practice Address - Street 1:750 MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-2516
Practice Address - Country:US
Practice Address - Phone:410-526-3017
Practice Address - Fax:410-584-1888
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD685201700Medicaid
MDG43497Medicare UPIN
MD685201700Medicaid
158064ZR0ZMedicare PIN
MD110143321Medicare PIN