Healthcare Provider Details

I. General information

NPI: 1992956247
Provider Name (Legal Business Name): RAHUL N CHAVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3298 SUMMIT BLVD STE 12
PENSACOLA FL
32503-4350
US

IV. Provider business mailing address

3298 SUMMIT BLVD STE 12
PENSACOLA FL
32503-4350
US

V. Phone/Fax

Practice location:
  • Phone: 850-518-3881
  • Fax: 850-746-0651
Mailing address:
  • Phone: 850-518-3881
  • Fax: 850-518-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberME127870
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME127870
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: