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NPI Code Detail

MEDICARE: VENKAT PAVAN REDDY KANCHARLA M.D

MEDICARE: VENKAT PAVAN REDDY KANCHARLA M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RX0202XMedical Oncology PhysicianME112590FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205091758
Entity Type Code : Individual
Provider Name (Legal Business Name) : VENKAT PAVAN REDDY KANCHARLA M.D
Provider Business Mailing Address
First Line : PO BOX 534595
Second Line :
City : ATLANTA
State : GA
Zip : 30353-4595
Country : US
Telephone Number : 321-725-8300
Fax Number : 321-725-1555
Provider Business Practice Location Address
First Line : 20 SAN FILIPPO DR SE
Second Line :
City : PALM BAY
State : FL
Zip : 32909-2200
Country : US
Telephone Number : 321-725-8300
Fax Number : 321-725-1555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2008
Last Update Date : 01/07/2019

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