Provider Demographics
NPI:1205048212
Name:PANCHOLI, RINIT H (MD)
Entity type:Individual
Prefix:DR
First Name:RINIT
Middle Name:H
Last Name:PANCHOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-272-5067
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:4420 DIXIE HWY., STE 112
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-3948
Practice Address - Country:US
Practice Address - Phone:502-449-6444
Practice Address - Fax:502-449-6445
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43380207Q00000X, 207P00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP400020309Medicare PIN
KYP400020310Medicare PIN
KYP400020311Medicare PIN