| Doctor Name: | JASON A PANEK |
| NPI Number: | 1093140261 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APNP |
| License Number: | 0024172801 |
| Business Practice Address: | 65 Brickyard Dr Dillwyn, VA - 239363361 |
| Business Phone Number: | 4349832722 |
| Business Fax Number: | 4349831383 |
| Mailing Address: | Po Box 75268, BALTIMORE |
| State: | MD |
| Postal Code: | 212755268 |
| Phone Number: | 4346547794 |
| Fax Number: | 4346547752 |
| NPI Enumeration Date: | 09/06/2013 |
| NPI Last Update Date: | 11/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0024172801 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |