Healthcare Provider Details

I. General information

NPI: 1972007565
Provider Name (Legal Business Name): ASHIL PANCHAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 BROADWAY DEPT 35
OAKLAND CA
94611-5730
US

IV. Provider business mailing address

3600 BROADWAY DEPT 35 - PULMONARY OFFICE
OAKLAND CA
94611
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-6555
  • Fax:
Mailing address:
  • Phone: 510-752-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA166570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: