Healthcare Provider Details

I. General information

NPI: 1790723880
Provider Name (Legal Business Name): HARRY T CHUGANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ROCKLAND ROAD
WILMINGTON DE
19803-3607
US

IV. Provider business mailing address

PO BOX 191 PROVIDER ENROLLMENT
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-4200
  • Fax: 302-651-5967
Mailing address:
  • Phone: 302-651-4000
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301062347
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number4301062347
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: