Provider Demographics
NPI:1780938928
Name:ANTHONY D. PANASCI MD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ANTHONY D. PANASCI MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PANASCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-254-0720
Mailing Address - Street 1:25880 TOURNAMENT RD
Mailing Address - Street 2:#222
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2349
Mailing Address - Country:US
Mailing Address - Phone:661-254-0720
Mailing Address - Fax:661-254-0860
Practice Address - Street 1:25880 TOURNAMENT RD
Practice Address - Street 2:#222
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2349
Practice Address - Country:US
Practice Address - Phone:661-254-0720
Practice Address - Fax:661-254-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92041Medicare UPIN