Provider Demographics
NPI:1952485179
Name:PANCHOLI, SAMIR (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:
Last Name:PANCHOLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8068 W SAHARA AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1973
Mailing Address - Country:US
Mailing Address - Phone:702-363-0240
Mailing Address - Fax:702-363-0256
Practice Address - Street 1:6910 S CIMARRON RD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2280
Practice Address - Country:US
Practice Address - Phone:702-363-0240
Practice Address - Fax:702-363-0256
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV1308207YS0123X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery