Provider Demographics
NPI:1699791913
Name:PATHAK, ANJALI K (MD)
Entity type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:K
Last Name:PATHAK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8096
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-275-2020
Mailing Address - Fax:314-275-8719
Practice Address - Street 1:10 BARNES WEST DR
Practice Address - Street 2:STE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6350
Practice Address - Country:US
Practice Address - Phone:314-996-3300
Practice Address - Fax:314-996-3301
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-10-26
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Provider Licenses
StateLicense IDTaxonomies
MO2001009907207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO111010103Medicaid
IL$$$$$$$$$Medicaid
MO180042826Medicare PIN
MO111010103Medicaid