Provider Demographics
NPI:1457413338
Name:NASHIKKAR, PANKAJ (MD)
Entity Type:Individual
Prefix:MR
First Name:PANKAJ
Middle Name:
Last Name:NASHIKKAR
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 1:2920 N CASCADE AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6262
Mailing Address - Country:US
Mailing Address - Phone:719-227-0027
Mailing Address - Fax:719-955-4058
Practice Address - Street 1:2920 N CASCADE AVE
Practice Address - Street 2:STE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6262
Practice Address - Country:US
Practice Address - Phone:719-227-0027
Practice Address - Fax:719-955-4058
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40770207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CONAB66175OtherBLUE SHIELD
CO54574838Medicaid
COP00384458OtherRAILROAD MEDICARE
CO509712ZVKQMedicare PIN
COC808314Medicare PIN
CONAB66175OtherBLUE SHIELD