Healthcare Provider Details

I. General information

NPI: 1164478129
Provider Name (Legal Business Name): RAVJYOT CHAWLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N MAIN ST STE 2B
HARRISON AR
72601-2911
US

IV. Provider business mailing address

PO BOX 2990
HARRISON AR
72602-2990
US

V. Phone/Fax

Practice location:
  • Phone: 870-414-4599
  • Fax: 870-741-7481
Mailing address:
  • Phone: 870-414-4599
  • Fax: 870-741-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0064319
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE-20155
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101253293
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD036005
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: