Provider Demographics
NPI:1093058877
Name:HERATH, KANCHANA NILUPUL (MD)
Entity Type:Individual
Prefix:
First Name:KANCHANA
Middle Name:NILUPUL
Last Name:HERATH
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1261 DIVISION HIGHWAY
Mailing Address - Street 2:STE 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-8822
Mailing Address - Country:US
Mailing Address - Phone:717-299-1301
Mailing Address - Fax:717-299-2214
Practice Address - Street 1:1261 DIVISION HIGHWAY
Practice Address - Street 2:STE 2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:17522-8822
Practice Address - Country:US
Practice Address - Phone:717-299-1301
Practice Address - Fax:717-299-2214
Is Sole Proprietor?:No
Enumeration Date:2013-03-31
Last Update Date:2018-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD465251207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology