Healthcare Provider Details

I. General information

NPI: 1144377128
Provider Name (Legal Business Name): JAGJIT CHADHA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W 4TH ST
DEQUINCY LA
70633-3508
US

IV. Provider business mailing address

140 W 4TH ST
DEQUINCY LA
70633-3508
US

V. Phone/Fax

Practice location:
  • Phone: 337-786-5007
  • Fax: 337-786-5009
Mailing address:
  • Phone: 337-786-5007
  • Fax: 337-786-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13083R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: