Provider Demographics
NPI:1700978509
Name:PANCHOLY, NAVIN C (MD)
Entity Type:Individual
Prefix:MR
First Name:NAVIN
Middle Name:C
Last Name:PANCHOLY
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 1:715 S HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-8352
Mailing Address - Country:US
Mailing Address - Phone:269-273-8471
Mailing Address - Fax:269-273-9680
Practice Address - Street 1:715 S HEALTH PKWY
Practice Address - Street 2:THREE RIVERS HEALTH
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-8352
Practice Address - Country:US
Practice Address - Phone:269-273-8471
Practice Address - Fax:269-273-9680
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA42880208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8374423Medicaid
D54017Medicare UPIN
WA8374423Medicaid