MEDICARE: DR. REKHA GOPAL PANVELKAR M.D.

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	GA-034432	GA

General Provider Information

NPI Number	:	1306929195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REKHA GOPAL PANVELKAR M.D.

Provider Business Mailing Address
First Line	:	626 23RD STREET
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904
Country	:	US
Telephone Number	:	706-660-1177
Fax Number	:	706-660-1098

Provider Business Practice Location Address
First Line	:	626 23RD ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8829
Country	:	US
Telephone Number	:	706-660-1177
Fax Number	:	706-660-1098

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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