Provider Demographics
NPI:1992902670
Name:PANKHANIYA, RAVI R (MD)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:R
Last Name:PANKHANIYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12219 KIRKDALE DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-3116
Mailing Address - Country:US
Mailing Address - Phone:415-506-7284
Mailing Address - Fax:650-360-2807
Practice Address - Street 1:10200 TRINITY PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-7286
Practice Address - Country:US
Practice Address - Phone:209-207-0555
Practice Address - Fax:209-916-4900
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA86587208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABE860WMedicare PIN
CABE860XMedicare PIN