Healthcare Provider Details

I. General information

NPI: 1073878716
Provider Name (Legal Business Name): NANGHA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 08/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 REGENCY PKWY SUITE 107
MANSFIELD TX
76063-5165
US

IV. Provider business mailing address

309 REGENCY PKWY SUITE 107
MANSFIELD TX
76063-5165
US

V. Phone/Fax

Practice location:
  • Phone: 817-477-5884
  • Fax: 877-613-9101
Mailing address:
  • Phone: 817-477-5884
  • Fax: 877-613-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN8773
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberN8959
License Number StateTX

VIII. Authorized Official

Name: DR. CHAITANYA B CHAVDA
Title or Position: DIRECTOR
Credential: MD
Phone: 214-207-4805