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General NPI Number Information
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NPI Number | 1962401471
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Entity Type | Individual
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Provider Name | ELLIOT J GINCHANSKY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7777 FOREST LN SUITE C530
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City | DALLAS
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State | TX
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Zip | 75230-2505
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Country | US
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Telephone | 972-566-7576
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Fax | 972-566-6177
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Provider Business Mailing Address
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Address Line | 6912 LA MANGA DR
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City | DALLAS
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State | TX
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Zip | 75248-2908
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Country | US
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Telephone |
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | E4847
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License Number State | TX
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