Basic Information
| Provider Information | |||||||||
| NPI: | 1720215817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANWAR | ||||||||
| FirstName: | NIRMALA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 PEMBROKE RD | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065142626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033935280 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1783 MERIDEN WATERBURY TPKE #13 | ||||||||
| Address2: | |||||||||
| City: | SOUTHINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064890648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034041010 | ||||||||
| FaxNumber: | 8604262898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2009 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 052442 | CT | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.