Provider Demographics
NPI:1265463061
Name:UPADHYAY, KANCHAN PRASAD (MD)
Entity Type:Individual
Prefix:MR
First Name:KANCHAN
Middle Name:PRASAD
Last Name:UPADHYAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-2901
Mailing Address - Country:US
Mailing Address - Phone:337-238-3475
Mailing Address - Fax:337-238-3617
Practice Address - Street 1:931 VERONE TER
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4255
Practice Address - Country:US
Practice Address - Phone:337-238-3475
Practice Address - Fax:337-238-3617
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13173R207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA260053101OtherTRICARE
LA260053101OtherMAILHANDLER
LA1578924Medicaid
LA260053101OtherSTATE GROUP
LA36-00370OtherUNITED HEALTH CARE
LAH64068Medicare UPIN
LA260053101OtherSTATE GROUP