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General NPI Number Information
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NPI Number | 1467081463
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Entity Type | Individual
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Provider Name | CHADLEY CARL DZORMEKU MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 1600 HOSPITAL PKWY
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City | BEDFORD
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State | TX
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Zip | 76022-6913
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Country | US
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Telephone | 817-848-2708
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Fax |
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Provider Business Mailing Address
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Address Line | 8900 VAN WYCK EXPY
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City | JAMAICA
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State | NY
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Zip | 11418-2832
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Country | US
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Telephone | 651-703-5209
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | U2475
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License Number State | TX
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