Provider Demographics
NPI:1578724571
Name:PAGHDAL, KAPILA V (MD)
Entity Type:Individual
Prefix:
First Name:KAPILA
Middle Name:V
Last Name:PAGHDAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ROUTE 17
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2010
Mailing Address - Country:US
Mailing Address - Phone:201-652-4536
Mailing Address - Fax:
Practice Address - Street 1:400 ROUTE 17
Practice Address - Street 2:SUITE 2
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2010
Practice Address - Country:US
Practice Address - Phone:201-652-4536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA09345800207NS0135X
FLME112585207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012209600Medicaid
FLHW814ZMedicare PIN