Healthcare Provider Details

I. General information

NPI: 1710160692
Provider Name (Legal Business Name): CHAITANYA B CHAVDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4927 LAKE RIDGE PKWY STE 148
GRAND PRAIRIE TX
75052-3087
US

IV. Provider business mailing address

4927 LAKE RIDGE PKWY STE 148
GRAND PRAIRIE TX
75052-3087
US

V. Phone/Fax

Practice location:
  • Phone: 972-217-4203
  • Fax: 833-784-1531
Mailing address:
  • Phone: 972-217-4203
  • Fax: 833-784-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN8773
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberN8773
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: