Healthcare Provider Details

I. General information

NPI: 1831185941
Provider Name (Legal Business Name): MARIE BLANCHE N TCHETGEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 MEDICAL ARTS DR STE 340
FLOWER MOUND TX
75028
US

IV. Provider business mailing address

3600 GASTON AVE STE 1205
DALLAS TX
75246-1812
US

V. Phone/Fax

Practice location:
  • Phone: 972-394-4500
  • Fax: 214-513-2059
Mailing address:
  • Phone: 214-692-8262
  • Fax: 214-513-2059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License NumberL3497
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberL3497
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: