Provider Demographics
NPI:1811984297
Name:JAIN, KANCHHEDI L (MD)
Entity type:Individual
Prefix:DR
First Name:KANCHHEDI
Middle Name:L
Last Name:JAIN
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 1:7223 HANOVER PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2023
Mailing Address - Country:US
Mailing Address - Phone:301-220-0031
Mailing Address - Fax:301-220-2240
Practice Address - Street 1:7223 HANOVER PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2023
Practice Address - Country:US
Practice Address - Phone:301-220-0031
Practice Address - Fax:301-220-2240
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025377174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD798841900Medicaid
DC187950L02Medicare PIN