Provider Demographics
NPI:1770994733
Name:PANIGRAHI, KALPANA PANDA
Entity type:Individual
Prefix:DR
First Name:KALPANA
Middle Name:PANDA
Last Name:PANIGRAHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 OCEAN AVE
Mailing Address - Street 2:APARTMENT 7A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1426
Mailing Address - Country:US
Mailing Address - Phone:561-213-8593
Mailing Address - Fax:
Practice Address - Street 1:2120 OCEAN AVE
Practice Address - Street 2:APARTMENT 7A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1426
Practice Address - Country:US
Practice Address - Phone:561-213-8593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282551207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program