Provider Demographics
NPI:1841365012
Name:PAHWA, ANJALA B (MD)
Entity type:Individual
Prefix:
First Name:ANJALA
Middle Name:B
Last Name:PAHWA
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 1:213 GREENHILL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-1844
Mailing Address - Country:US
Mailing Address - Phone:302-429-5870
Mailing Address - Fax:302-429-9284
Practice Address - Street 1:213 GREENHILL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1844
Practice Address - Country:US
Practice Address - Phone:302-429-5870
Practice Address - Fax:302-429-9284
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000015051Medicaid
H68721Medicare UPIN
010035F85Medicare ID - Type Unspecified