Provider Demographics
NPI:1649258492
Name:MCMAHAN, KANCHAN PURANIK (MD)
Entity type:Individual
Prefix:
First Name:KANCHAN
Middle Name:PURANIK
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 APPALOOSA WAY
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-0316
Mailing Address - Country:US
Mailing Address - Phone:704-616-3589
Mailing Address - Fax:704-671-7678
Practice Address - Street 1:3250 FREEDOM DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-2817
Practice Address - Country:US
Practice Address - Phone:704-659-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36583207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8945720Medicaid
NC8945720Medicaid
N30144Medicare UPIN