Provider Demographics
NPI:1295757292
Name:DAVID H PANOSSIAN MD PC
Entity type:Organization
Organization Name:DAVID H PANOSSIAN MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-885-2201
Mailing Address - Street 1:2614 ALMOND ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1117
Mailing Address - Country:US
Mailing Address - Phone:541-885-2201
Mailing Address - Fax:541-883-1400
Practice Address - Street 1:2614 ALMOND ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1117
Practice Address - Country:US
Practice Address - Phone:541-885-2201
Practice Address - Fax:541-883-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR131357Medicare PIN
OR7558610001Medicare NSC