Basic Information
| Provider Information | |||||||||
| NPI: | 1588601330 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PANCHOLI | ||||||||
| FirstName: | YOGESH | ||||||||
| MiddleName: | BIPIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4332 POST RD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028184203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018850063 | ||||||||
| FaxNumber: | 4018850063 | ||||||||
| Practice Location | |||||||||
| Address1: | 3616 S I 10 SERVICE RD W STE 100 | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700011874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048385257 | ||||||||
| FaxNumber: | 5048385284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 04/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD10616 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0000X | RI 10616 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine | 207R00000X | MD.207277 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.