Provider Demographics
NPI:1962606863
Name:PANCHOLY, VASANTI G (MD)
Entity type:Individual
Prefix:
First Name:VASANTI
Middle Name:G
Last Name:PANCHOLY
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 1:4108 MILDENHALL DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3144
Mailing Address - Country:US
Mailing Address - Phone:972-312-8820
Mailing Address - Fax:
Practice Address - Street 1:4108 MILDENHALL DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3144
Practice Address - Country:US
Practice Address - Phone:972-312-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2800207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B73596Medicare UPIN