Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD429573 | PA |
N | 111NI0900X | Internist | MD429573 | PA |
Y | 207RN0300X | Nephrologist | 065864 | GA |
NPI | 1033132212 |
---|---|
Provider Name | Sagar Jayant Panse |
First Address | Macon, GA 31201-6863 |
Second Address | Macon, GA 31201-6863 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 12/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003110313A | (05) | GA |