Healthcare Provider Details

I. General information

NPI: 1548496904
Provider Name (Legal Business Name): KUNAL PANDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 06/29/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE DEPT OF
ROCHESTER NY
14642-2604
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 604
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-276-3294
  • Fax:
Mailing address:
  • Phone: 585-276-3294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberQ0146
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number285844-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number285844
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number284844
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: