Provider Demographics
NPI:1770821621
Name:KACHALIA, AMIT GIRISH (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:GIRISH
Last Name:KACHALIA
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 1:2356 FREEDOM BLVD APT A8
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6093
Mailing Address - Country:US
Mailing Address - Phone:631-988-6092
Mailing Address - Fax:
Practice Address - Street 1:805 PAMPLICO HWY
Practice Address - Street 2:SUITE B135,
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6093
Practice Address - Country:US
Practice Address - Phone:843-674-6407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD36550208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist