Provider Demographics
NPI:1003260274
Name:PANCHAL, ANKUR
Entity Type:Individual
Prefix:
First Name:ANKUR
Middle Name:
Last Name:PANCHAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 WILMINGTON AVE
Mailing Address - Street 2:JAMESON HOSPITAL
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-2516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1211 WILMINGTON AVE
Practice Address - Street 2:JAMESON HOSPITAL
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-2516
Practice Address - Country:US
Practice Address - Phone:724-656-4264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD468176207R00000X
OH35.136556207R00000X
CAA161959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine