MEDICARE: DR. RICHARD PANVINI D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	N004421	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013918846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD PANVINI D.P.M.

Provider Business Mailing Address
First Line	:	2 MCLANE DR
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-5509
Country	:	US
Telephone Number	:	631-595-1511
Fax Number	:	631-595-1511

Provider Business Practice Location Address
First Line	:	2 MCLANE DR
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-5509
Country	:	US
Telephone Number	:	631-595-1511
Fax Number	:	631-595-1511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/04/2010

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