Provider Demographics
NPI:1376542373
Name:PANCHWAGH, RAJESH R (DO)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:R
Last Name:PANCHWAGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-5120
Mailing Address - Fax:717-741-3075
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8200
Practice Address - Country:US
Practice Address - Phone:717-812-5120
Practice Address - Fax:717-741-3075
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012330207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD973500OtherCAREFIRST MD BCBS-WMG
PA30089002OtherAMERIHEALTH MERCY-WMG
PA416565OtherUPMC-WMG
PA50001532OtherCAPITAL BLUE CROSS
PA1527731OtherGATEWAY-WMG
PA10016481OtherRAILROAD MEDICARE
PA0019571230002Medicaid
PA1401155OtherHIGHMARK BLUE SHIELD
H62239Medicare UPIN
MD973500OtherCAREFIRST MD BCBS-WMG
PA058439Medicare PIN
PA1527731OtherGATEWAY-WMG