Provider Demographics
NPI:1760171102
Name:PANCHAL, POOJA (DO)
Entity Type:Individual
Prefix:DR
First Name:POOJA
Middle Name:
Last Name:PANCHAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 STOWE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-6508
Mailing Address - Country:US
Mailing Address - Phone:704-689-6929
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN ST RM 3T72
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2196
Practice Address - Country:US
Practice Address - Phone:313-745-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program