Basic Information
| Provider Information | |||||||||
| NPI: | 1093980518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KACHHADIYA | ||||||||
| FirstName: | GOVINDBHAI | ||||||||
| MiddleName: | PARSHOTTAMBHAI | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178514740 | ||||||||
| FaxNumber: | 7177386872 | ||||||||
| Practice Location | |||||||||
| Address1: | 169 MARTIN AVE | ||||||||
| Address2: | |||||||||
| City: | EPHRATA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175221724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177218195 | ||||||||
| FaxNumber: | 7177336010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2008 | ||||||||
| LastUpdateDate: | 04/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD440887 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | 01063004A | IN | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 247133 | NY | N | Allopathic & Osteopathic Physicians | General Practice | 208M00000X | MD440887 | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1013977730026 | 05 | PA | MEDICAID | 190001VOU | 01 | PA | MEDICARE | OTHER |