Healthcare Provider Details

I. General information

NPI: 1265528343
Provider Name (Legal Business Name): PANKAJ SANWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21141 STERLING AVE SUITE 1
GEORGETOWN DE
19947-5563
US

IV. Provider business mailing address

21141 STERLING AVE SUITE 1
GEORGETOWN DE
19947-5571
US

V. Phone/Fax

Practice location:
  • Phone: 302-856-3969
  • Fax: 302-856-3140
Mailing address:
  • Phone: 302-856-6967
  • Fax: 302-855-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC10005413
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: