MEDICARE: SIDHARTHA PANI 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	207R00000X	Internal Medicine Physician	202636	MA
2	207R00000X	Internal Medicine Physician	0101230906	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2959888-002	OTHER	MA	CIGNAPAL
2	409720	OTHER	MA	BCBSRI BLUE CHIP
3	97384602	OTHER	MA	NETWORKHEALTH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2959888	OTHER	MA	CIGNA
6	456086	OTHER	MA	TUFTS HEALTH PLAN
7	0028365	OTHER	MA	NEIGHBORHOD HEALTH PLAN
8	29421-0	OTHER	MA	BCBSRI
9	3756469	OTHER	MA	AETNA
10	AA31394	OTHER	MA	HARVARD PILGRIM
11	000000029129	OTHER	MA	BMC HEALTHNET
12	004450	OTHER	MA	SENIORWHOLEHEALTH
13	J24451	OTHER	MA	BCBSMA
14	042675800	OTHER	MA	UNITED HEALTH

General Provider Information

NPI Number	:	1619924370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDHARTHA PANI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9007
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22906-9007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1222 JEFFERSON PARK AVE
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22903-3410
Country	:	US
Telephone Number	:	434-982-3040
Fax Number	:	434-245-3535

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	12/02/2023

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