Provider Demographics
NPI:1932413259
Name:KANCHARLA, ADARSH REDDY (MD)
Entity Type:Individual
Prefix:
First Name:ADARSH
Middle Name:REDDY
Last Name:KANCHARLA
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6287
Practice Address - Fax:864-560-7091
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25331208000000X
WI56601208000000X
SC83531208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810026559Medicaid
SC835314Medicaid
SCSCI0663365OtherMEDICARE PIN
SCSCI0665019OtherMEDICARE PIN