Healthcare Provider Details

I. General information

NPI: 1942271937
Provider Name (Legal Business Name): PANAKKAL DAVID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

M/MED/MHS, 2402 E STREET, NW L-223
WASHINGTON DC
20522-0001
US

IV. Provider business mailing address

7 SHADY GLN
BALLSTON LAKE NY
12019-9219
US

V. Phone/Fax

Practice location:
  • Phone: 202-663-1903
  • Fax:
Mailing address:
  • Phone: 703-399-9726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number160517
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: