Provider Demographics
NPI:1790779031
Name:PANCHOLI, MEETA (DPM)
Entity Type:Individual
Prefix:
First Name:MEETA
Middle Name:
Last Name:PANCHOLI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 PINE COVE CT
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-9256
Mailing Address - Country:US
Mailing Address - Phone:570-283-1150
Mailing Address - Fax:
Practice Address - Street 1:3295 FOREST INN RD
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-5467
Practice Address - Country:US
Practice Address - Phone:610-826-3338
Practice Address - Fax:610-824-7229
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004248L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA097265OtherPTAN