Provider Demographics
NPI:1588601330
Name:PANCHOLI, YOGESH BIPIN (MD)
Entity Type:Individual
Prefix:
First Name:YOGESH
Middle Name:BIPIN
Last Name:PANCHOLI
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 1:4332 POST RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02818-4203
Mailing Address - Country:US
Mailing Address - Phone:401-885-0063
Mailing Address - Fax:401-885-0063
Practice Address - Street 1:3616 S I 10 SERVICE RD W STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1874
Practice Address - Country:US
Practice Address - Phone:504-838-5257
Practice Address - Fax:504-838-5284
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10616207R00000X
RIRI 10616207RA0000X
LAMD.207277207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIH42677Medicare UPIN