Basic Information
| Provider Information | |||||||||
| NPI: | 1467440891 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANELLI-RAMERY | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 COOLIDGE BLVD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372898400 | ||||||||
| FaxNumber: | 3372898401 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 COOLIDGE BLVD | ||||||||
| Address2: | SUITE100 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372898400 | ||||||||
| FaxNumber: | 3372898401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 03/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 24025 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207R00000X | 24025 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 900004234 | 01 | LA | RAILROAD MEDICARE | OTHER | 1481068 | 05 | LA | MEDICAID |