Provider Demographics
NPI:1902131550
Name:PANJWANI, SURESH (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:
Last Name:PANJWANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HARPER CLOSE
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:GB
Mailing Address - Zip Code:N14 4ES
Mailing Address - Country:GB
Mailing Address - Phone:208-344-3130
Mailing Address - Fax:
Practice Address - Street 1:FOREST PRIMARY CARE CENTRE
Practice Address - Street 2:308 A HEARTFORD ROAD
Practice Address - City:LONDON
Practice Address - State:GB
Practice Address - Zip Code:N97HD
Practice Address - Country:GB
Practice Address - Phone:208-344-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine