Provider Demographics
NPI:1851462782
Name:PANCHADCHARAM GNANESWARAN MD PA
Entity type:Organization
Organization Name:PANCHADCHARAM GNANESWARAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PANCHADCHARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GNANESWARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-392-8000
Mailing Address - Street 1:PO BOX 3012
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-0012
Mailing Address - Country:US
Mailing Address - Phone:302-224-5678
Mailing Address - Fax:302-224-2848
Practice Address - Street 1:204 SOUTH ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5633
Practice Address - Country:US
Practice Address - Phone:410-392-8000
Practice Address - Fax:410-392-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD091MMedicare ID - Type Unspecified