Healthcare Provider Details

I. General information

NPI: 1740035989
Provider Name (Legal Business Name): GUNJAN CHADHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date: 12/19/2024
Reactivation Date: 01/15/2025

III. Provider practice location address

2575 E EVERGREEN DR
APPLETON WI
54913-8910
US

IV. Provider business mailing address

2575 E EVERGREEN DR
APPLETON WI
54913-8910
US

V. Phone/Fax

Practice location:
  • Phone: 412-538-3164
  • Fax:
Mailing address:
  • Phone: 412-588-3164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License NumberLT001009
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: