Healthcare Provider Details

I. General information

NPI: 1376542373
Provider Name (Legal Business Name): RAJESH R PANCHWAGH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 FREEDOM WAY SUITE 200
YORK PA
17402-8200
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-5120
  • Fax: 717-741-3075
Mailing address:
  • Phone: 717-812-5120
  • Fax: 717-741-3075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOS012330
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: