Healthcare Provider Details

I. General information

NPI: 1992168918
Provider Name (Legal Business Name): AVINASH CHAURASIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BROOKE ARMY MEDICAL CENTER, RADIATION ONCOLOGY 3551 ROGER BROOKE DRIVE
FORT SAM HOUSTON TX
78234-0001
US

IV. Provider business mailing address

BROOKE ARMY MEDICAL CENTER, DEPT. OF RADIATION ONCOLOGY 3551 ROGER BROOKE DRIVE
FORT SAM HOUSTON TX
78234
US

V. Phone/Fax

Practice location:
  • Phone: 210-539-9582
  • Fax: 210-916-0330
Mailing address:
  • Phone: 210-916-5046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberT2139
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: