Provider Demographics
NPI:1609864248
Name:KASHYAP, PANKAJ KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PANKAJ
Middle Name:KUMAR
Last Name:KASHYAP
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 1:1717 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-3832
Mailing Address - Country:US
Mailing Address - Phone:256-237-3284
Mailing Address - Fax:256-237-4104
Practice Address - Street 1:1717 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-3832
Practice Address - Country:US
Practice Address - Phone:256-237-3284
Practice Address - Fax:256-237-4104
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6311286628174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529909260Medicaid
AL529909260Medicaid
ALF16263Medicare UPIN