Healthcare Provider Details

I. General information

NPI: 1750739686
Provider Name (Legal Business Name): ANNA PANCHESHNIKOV M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6012 MAIN ST
VOORHEES NJ
08043-4659
US

IV. Provider business mailing address

800 HOWARD AVE YNHH-OBSTETRICS & GYNECOLOGY
NEW HAVEN CT
06519-1369
US

V. Phone/Fax

Practice location:
  • Phone: 856-325-6622
  • Fax: 856-325-6522
Mailing address:
  • Phone: 203-785-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number25MA11916300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: