Provider Demographics
NPI:1831277425
Name:FRUCHTMAN, PARINDA KANAIYALAL (MD)
Entity type:Individual
Prefix:DR
First Name:PARINDA
Middle Name:KANAIYALAL
Last Name:FRUCHTMAN
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 1:105 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-7746
Mailing Address - Country:US
Mailing Address - Phone:704-630-0097
Mailing Address - Fax:
Practice Address - Street 1:1406A W INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2502
Practice Address - Country:US
Practice Address - Phone:704-639-0407
Practice Address - Fax:704-639-9599
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890208LMedicaid
NC0208LOtherBCBS
NC0208LOtherBCBS