Healthcare Provider Details

I. General information

NPI: 1639185465
Provider Name (Legal Business Name): THIRUMALESHAWAR KANCHANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PRASAD KANCHANA

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 STANTON CHRISTIANA RD SUITE 203 MID ATLANTIC GI CONSULTANTS
NEWARK DE
19713
US

IV. Provider business mailing address

537 STANTON CHRISTIANA RD SUITE 203 MID ATLANTIC GI CONSULTANTS
NEWARK DE
19713
US

V. Phone/Fax

Practice location:
  • Phone: 302-225-2380
  • Fax: 302-225-2388
Mailing address:
  • Phone: 302-225-2380
  • Fax: 302-225-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC10006987
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: