Healthcare Provider Details

I. General information

NPI: 1073503355
Provider Name (Legal Business Name): KANCHAN PANDURANG KULKARNI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDSTAR MEDICAL GROUP RADIOLOGY 4061 POWDER MILL RD. SUITE 210
CALVERTON MD
20705
US

IV. Provider business mailing address

MEDSTAR MEDICAL GROUP RADIOLOGY 4061 POWDER MILL RD. SUITE 210
CALVERTON MD
20705
US

V. Phone/Fax

Practice location:
  • Phone: 301-902-1073
  • Fax: 301-902-1086
Mailing address:
  • Phone: 301-902-1073
  • Fax: 301-902-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD425400
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberMD035143
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: