Basic Information
| Provider Information | |||||||||
| NPI: | 1467488106 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANIGRAHI | ||||||||
| FirstName: | GUNADHAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 BUSINESS PARK DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234626335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579621083 | ||||||||
| FaxNumber: | 7579621254 | ||||||||
| Practice Location | |||||||||
| Address1: | 1925 GLENN MITCHELL DR | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234560170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575070702 | ||||||||
| FaxNumber: | 7579621254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2006 | ||||||||
| LastUpdateDate: | 08/12/2011 | ||||||||
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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 | 207RC0000X | 0101035440 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 269854 | 01 | VA | ANTHEM | OTHER | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | -001 | 01 | VA | TRICARE/CHAMPUS | OTHER | 10015734 | 01 | VA | SENTARA OPTIMA | OTHER | 12375 | 01 | VA | OPTIMA HEALTH PLAN | OTHER | PAR | 01 | VA | AETNA | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | 010226589 | 05 | VA | MEDICAID | PAR | 01 | VA | CIGNA | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | 06381 | 01 | NC | BC/BS | OTHER | 1467488106 | 05 | VA | MEDICAID | 187094 | 01 | VA | ANTHEM BC/BS | OTHER | 413774 | 01 | UHC/MAMSI | OTHER | 8906381 | 05 | NC | MEDICAID | 313774 | 01 | VA | MAMSI | OTHER | PAR | 01 | VA | CORVEL/CORCARE | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER | PAR | 01 | VA | VIRGINIA PREMIER HEALTH | OTHER |