Healthcare Provider Details

I. General information

NPI: 1205866183
Provider Name (Legal Business Name): DIPAK PANIGRAHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3553 16TH ST NW
WASHINGTON DC
20010-3041
US

IV. Provider business mailing address

3553 16TH ST NW
WASHINGTON DC
20010-3041
US

V. Phone/Fax

Practice location:
  • Phone: 202-387-8900
  • Fax: 202-328-0565
Mailing address:
  • Phone: 202-387-8900
  • Fax: 202-328-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD035638
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101238649
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: