Provider Demographics
NPI:1497880512
Name:PANJWANI, ANUP (OD)
Entity type:Individual
Prefix:DR
First Name:ANUP
Middle Name:
Last Name:PANJWANI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 WATKINS MILL DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-6448
Mailing Address - Country:US
Mailing Address - Phone:904-502-6075
Mailing Address - Fax:904-207-7933
Practice Address - Street 1:3838 WATKINS MILL DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-6448
Practice Address - Country:US
Practice Address - Phone:904-502-6075
Practice Address - Fax:904-207-7933
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3506152W00000X
VA0618002102152W00000X
MDTA2294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003659300Medicaid
MD052828500Medicaid
FL003659300Medicaid
MD052828500Medicaid