Provider Demographics
NPI:1073503355
Name:KULKARNI, KANCHAN PANDURANG (MD)
Entity Type:Individual
Prefix:DR
First Name:KANCHAN
Middle Name:PANDURANG
Last Name:KULKARNI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:MEDSTAR MEDICAL GROUP RADIOLOGY
Mailing Address - Street 2:4061 POWDER MILL RD. SUITE 210
Mailing Address - City:CALVERTON
Mailing Address - State:MD
Mailing Address - Zip Code:20705
Mailing Address - Country:US
Mailing Address - Phone:301-902-1073
Mailing Address - Fax:301-902-1086
Practice Address - Street 1:MEDSTAR MEDICAL GROUP RADIOLOGY
Practice Address - Street 2:4061 POWDER MILL RD. SUITE 210
Practice Address - City:CALVERTON
Practice Address - State:MD
Practice Address - Zip Code:20705
Practice Address - Country:US
Practice Address - Phone:301-902-1073
Practice Address - Fax:301-902-1086
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2019-11-19
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Provider Licenses
StateLicense IDTaxonomies
PAMD4254002085R0202X
DCMD035143207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101651037Medicaid
I20861Medicare UPIN
015124N96Medicare ID - Type Unspecified