Provider Demographics
NPI:1043336142
Name:PANCHOLY, DIPTI SAMIR (MD)
Entity Type:Individual
Prefix:
First Name:DIPTI
Middle Name:SAMIR
Last Name:PANCHOLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:CHINCHILLA
Mailing Address - State:PA
Mailing Address - Zip Code:18410-0602
Mailing Address - Country:US
Mailing Address - Phone:570-840-0162
Mailing Address - Fax:570-343-4800
Practice Address - Street 1:501 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2401
Practice Address - Country:US
Practice Address - Phone:570-343-2383
Practice Address - Fax:570-343-4800
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055244L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine