=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720767924
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOGA RAO CHAGANTI MD, FRANZCR, PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2023
-----------------------------------------------------
Last Update Date | 07/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 132 S 10TH STREETS MAIN BUIDING
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-955-2998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1414 S PENN SQ UNIT 33H
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19102-2551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-332-4145
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085N0700X
-----------------------------------------------------
Taxonomy Name | Neuroradiology Physician
-----------------------------------------------------
License Number | MD479873
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------