MEDICARE: DR. ANALA PANCHUMARTI DMD

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	122300000X	Dentist	DN 18085	FL
2	1223G0001X	General Practice Dentistry	22227	TX

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	:	1518920909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANALA PANCHUMARTI DMD

Provider Business Mailing Address
First Line	:	4714 N.ARMENIA AVE, SUITE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603
Country	:	US
Telephone Number	:	813-876-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4714 N ARMENIA AVE
Second Line	:	SUITE 102
City	:	TAMPA
State	:	FL
Zip	:	33603-2603
Country	:	US
Telephone Number	:	813-876-1200
Fax Number	:

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

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	10/05/2012

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