Provider Demographics
NPI:1720279599
Name:PANCHAL, VISHAL (MD)
Entity Type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:
Last Name:PANCHAL
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 1:2125 OAK GROVE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2536
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:925-296-7171
Practice Address - Street 1:2125 OAK GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2536
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:925-296-7171
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1074782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGD484DMedicare PIN
CAGD484NMedicare PIN
CAGD484BMedicare PIN
CAGD484EMedicare PIN
CAGD484FMedicare PIN
CAGD484JMedicare PIN
CAGD484MMedicare PIN
CAGD484CMedicare PIN
CAGD484OMedicare PIN
CAGD484IMedicare PIN
CAGD484LMedicare PIN
CAGD484QMedicare PIN
CAGD484RMedicare PIN
CAGD484SMedicare PIN
CAGD484VMedicare PIN
CAGD484TMedicare PIN
CAGD484UMedicare PIN
CAGD484GMedicare PIN
CAGD484HMedicare PIN
CAGD484PMedicare PIN
CAGD484AMedicare PIN
CAGD484KMedicare PIN