Provider Demographics
NPI:1821730904
Name:PANICKER, EVANGEL (DO)
Entity type:Individual
Prefix:DR
First Name:EVANGEL
Middle Name:
Last Name:PANICKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7240 PATTERSON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6751
Mailing Address - Country:US
Mailing Address - Phone:804-282-4205
Mailing Address - Fax:
Practice Address - Street 1:7240 PATTERSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6751
Practice Address - Country:US
Practice Address - Phone:804-282-4205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-10
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116036282208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics