Healthcare Provider Details

I. General information

NPI: 1962634188
Provider Name (Legal Business Name): NITIN CHANANA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 07/21/2022
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7888 GATEWAY BLVD E FL 2
EL PASO TX
79915-1815
US

IV. Provider business mailing address

4601 GLOBE WILLOW DR SUITE 100
EL PASO TX
79922-2221
US

V. Phone/Fax

Practice location:
  • Phone: 915-315-2584
  • Fax: 915-315-2584
Mailing address:
  • Phone: 630-240-3576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ2435
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberQ2435
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: