Provider Demographics
NPI:1750739686
Name:PANCHESHNIKOV, ANNA (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PANCHESHNIKOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HOWARD AVE
Mailing Address - Street 2:YNHH-OBSTETRICS & GYNECOLOGY
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1369
Mailing Address - Country:US
Mailing Address - Phone:203-785-4004
Mailing Address - Fax:
Practice Address - Street 1:6012 MAIN ST
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4659
Practice Address - Country:US
Practice Address - Phone:856-325-6622
Practice Address - Fax:856-325-6522
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA11916300207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program