Provider Demographics
NPI:1396148573
Name:ANANTH, PAVAN KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:PAVAN
Middle Name:KUMAR
Last Name:ANANTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 E 93RD ST APT 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5582
Mailing Address - Country:US
Mailing Address - Phone:614-554-5906
Mailing Address - Fax:
Practice Address - Street 1:1978 CROMPOND RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4111
Practice Address - Country:US
Practice Address - Phone:914-736-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA80556207V00000X
390200000X
NY298225207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program