Provider Demographics
NPI:1063864924
Name:PANCHAL, JIGAR
Entity Type:Individual
Prefix:
First Name:JIGAR
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 1:245 N 15TH ST, 6TH FLOOR
Mailing Address - Street 2:DREXEL UNIVERSITY COLLEGE OF MEDICINE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102
Mailing Address - Country:US
Mailing Address - Phone:215-762-7000
Mailing Address - Fax:215-762-7765
Practice Address - Street 1:245 N 15TH ST, 6TH FLOOR
Practice Address - Street 2:DREXEL UNIVERSITY COLLEGE OF MEDICINE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102
Practice Address - Country:US
Practice Address - Phone:215-762-7000
Practice Address - Fax:215-762-7765
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-04
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT212119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine