Provider Demographics
NPI:1316908742
Name:NAGPAL, ANITA (PA)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:NAGPAL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756
Mailing Address - Country:US
Mailing Address - Phone:570-546-5009
Mailing Address - Fax:
Practice Address - Street 1:604 FOX HOLLOW CIRCLE
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756
Practice Address - Country:US
Practice Address - Phone:570-546-5009
Practice Address - Fax:570-546-4165
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2015-11-10
Deactivation Date:2015-07-23
Deactivation Code:
Reactivation Date:2015-11-10
Provider Licenses
StateLicense IDTaxonomies
PAMA051553363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ08747OtherHEALTHAMERICA
PA2518864OtherUNITEDHEALTHCARE
Q08747Medicare UPIN
PA2518864OtherUNITEDHEALTHCARE