Basic Information
| Provider Information | |||||||||
| NPI: | 1427125053 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANARESE | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | VINCENT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 534595 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303534595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214537440 | ||||||||
| FaxNumber: | 3214526687 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 CONE RD | ||||||||
| Address2: | |||||||||
| City: | MERRITT ISLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329523114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214537440 | ||||||||
| FaxNumber: | 3214526687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 07/20/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | ME 96595 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | L0481 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.