MEDICARE: DR PANICKER AND ASSOCIATES LLC

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	208000000X	Pediatrics Physician	ME86983	FL

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	:	1144693649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR PANICKER AND ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	5411 GRAND BLVD
Second Line	:	SUITE 102
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4010
Country	:	US
Telephone Number	:	727-849-2535
Fax Number	:

Provider Business Practice Location Address
First Line	:	5411 GRAND BLVD
Second Line	:	SUITE 102
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4010
Country	:	US
Telephone Number	:	727-849-2535
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. USHA PANICKER
Credential	:	MD
Telephone Number	:	727-849-2535

Provider Enumeration Date	:	11/05/2015
Last Update Date	:	11/05/2015

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Directions to “DR PANICKER AND ASSOCIATES LLC ” Practice Location

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