Provider Demographics
NPI:1538239736
Name:PANICKER, USHA SOMASUNDARA (MD)
Entity type:Individual
Prefix:DR
First Name:USHA
Middle Name:SOMASUNDARA
Last Name:PANICKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8698 BUTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-4319
Mailing Address - Country:US
Mailing Address - Phone:727-545-4966
Mailing Address - Fax:727-545-4966
Practice Address - Street 1:5341 GRAND BLVD STE 108
Practice Address - Street 2:RICHEY MEDICAL CENTER
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4011
Practice Address - Country:US
Practice Address - Phone:727-849-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86983208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics