Individual
PANKAJ WATAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6535 NEMOURS PKWY, ORLANDO, FL 32827-7884
(407) 567-4000
(407) 567-5924
Mailing address
10140 CENTURION PARKWAY N, FL PROVIDER ENROLLMENT, JACKSONVILLE, FL 32256-0532
(904) 697-4100
(904) 697-5102
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
R-10175
IA
2085P0229X
Pediatric Radiology Physician
C1-0013054
DE
2085P0229X
Pediatric Radiology Physician
Primary
ME139515
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102951100
—
FL
Enumeration date
07/22/2015
Last updated
09/22/2020
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