Healthcare Provider Details

I. General information

NPI: 1700223138
Provider Name (Legal Business Name): RYANE NICHOL PANASITI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

18 BOVENSIEPEN CT
ROSELAND NJ
07068-1126
US

V. Phone/Fax

Practice location:
  • Phone: 267-426-7949
  • Fax:
Mailing address:
  • Phone: 626-893-6030
  • 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 Code207ZP0213X
TaxonomyPediatric Pathology Physician
License NumberMT216255
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: