Provider Demographics
NPI:1275735276
Name:PANCHAMIA, SIDHARTH (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDHARTH
Middle Name:
Last Name:PANCHAMIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SID
Other - Middle Name:
Other - Last Name:PANCHAMIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3140 S FALKENBURG RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-2574
Mailing Address - Country:US
Mailing Address - Phone:813-533-5522
Mailing Address - Fax:813-533-5511
Practice Address - Street 1:3140 S FALKENBURG RD STE 205
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-2594
Practice Address - Country:US
Practice Address - Phone:813-533-5522
Practice Address - Fax:813-533-5511
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 106682207L00000X
FLME106682208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01279725OtherRR MEDICARE
FL002684500Medicaid
FL002684500Medicaid
FLDR490X - TAMPAMedicare PIN