Healthcare Provider Details

I. General information

NPI: 1295790640
Provider Name (Legal Business Name): ANJANA L PETTIGREW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE STREET
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

2333 ALUMNI PARK PLZ SUITE 200
LEXINGTON KY
40517-4012
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5425
  • Fax:
Mailing address:
  • Phone: 859-257-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License Number26584
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number26584
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number26584
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number26584
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: