Healthcare Provider Details

I. General information

NPI: 1932245602
Provider Name (Legal Business Name): RABI KUMAR PANIGRAHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 05/12/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST BLALOCK 1410
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

99 EAST HARTFORD DRIVE
EAST HARTFORD CT
06108-7301
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-7609
  • Fax:
Mailing address:
  • Phone: 860-282-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberT1811
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: