Provider Demographics
NPI:1831118819
Name:PANCHAL, RUPA (MD)
Entity type:Individual
Prefix:
First Name:RUPA
Middle Name:
Last Name:PANCHAL
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 1:5 ELKRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3179
Mailing Address - Country:US
Mailing Address - Phone:732-567-5853
Mailing Address - Fax:732-901-3966
Practice Address - Street 1:200 CANDLEWOOD CMNS
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2169
Practice Address - Country:US
Practice Address - Phone:908-312-0543
Practice Address - Fax:732-901-3966
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07606800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H31217Medicare UPIN