Provider Demographics
NPI:1215107529
Name:RASHIDA K KANCHWALA MD PC
Entity type:Organization
Organization Name:RASHIDA K KANCHWALA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RASHIDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:KANCHWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-534-6308
Mailing Address - Street 1:1088 W BALTIMORE PIKE
Mailing Address - Street 2:HCCII, SUITE #2105
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5146
Mailing Address - Country:US
Mailing Address - Phone:610-534-6308
Mailing Address - Fax:610-994-3384
Practice Address - Street 1:1088 W BALTIMORE PIKE
Practice Address - Street 2:HCC IISUITE #2105
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5146
Practice Address - Country:US
Practice Address - Phone:610-534-6308
Practice Address - Fax:610-994-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029048E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC34845Medicare UPIN
PA538638Medicare PIN