Provider Demographics
NPI:1407808454
Name:PANCHAL, NEERAJ J (MD)
Entity Type:Individual
Prefix:DR
First Name:NEERAJ
Middle Name:J
Last Name:PANCHAL
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:PO BOX 23540
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-3540
Mailing Address - Country:US
Mailing Address - Phone:858-565-0950
Mailing Address - Fax:858-565-2863
Practice Address - Street 1:8745 AERO DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1761
Practice Address - Country:US
Practice Address - Phone:858-565-0950
Practice Address - Fax:858-565-2863
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA831422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083812Medicaid
CAGR0083817Medicaid
CAGR0083815Medicaid
CAZZZ75341ZMedicaid
CAGR0083810Medicaid
CAGR0083811Medicaid
CAGR0083814Medicaid
CAGR0083816Medicaid
CAGR0083813Medicaid
CATD009Medicare PIN
CATD009AMedicare PIN
CAGR0083812Medicaid
CATP110Medicare PIN
CAGR0083816Medicaid
CAW529AMedicare PIN
CAGR0083815Medicaid
CAGR0083814Medicaid
CAZZZ75341ZMedicaid