Active NPI
Nirmala Panda, MD
- Pediatrics Physician
- Mount Laurel, NJ
National Provider Identifier
1780692616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MA03543400
- Practice address
- 813 East Gate Drive
Mount Laurel, NJ 08054 - Phone
- (856) 914-1770
- Fax
- (856) 914-1773
- NPI assigned
- Aug 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 25MA03543400 | NJ | Primary |
Addresses
Primary practice location
813 East Gate Drive
Mount Laurel, NJ 08054
Mailing address
813 East Gate Drive
Mount Laurel, NJ 08054
Phone (856) 914-1770
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0652806 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA03543400 | NJ | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383091200000",
"number": "1780692616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "813 EAST GATE DRIVE",
"city": "MOUNT LAUREL",
"state": "NJ",
"postal_code": "08054",
"telephone_number": "856-914-1770",
"fax_number": "856-914-1773"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "813 EAST GATE DRIVE",
"city": "MOUNT LAUREL",
"state": "NJ",
"postal_code": "08054",
"telephone_number": "856-914-1770",
"fax_number": "856-914-1773"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANDA",
"first_name": "NIRMALA",
"name_prefix": "Mrs.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-04",
"last_updated": "2013-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MA03543400",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0652806",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Laurel, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.