Provider Demographics
NPI:1033288451
Name:PURKAYASTHA, TANIA (MD)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:PURKAYASTHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W COLLEGE ST STE 130
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3575
Mailing Address - Country:US
Mailing Address - Phone:214-689-7806
Mailing Address - Fax:214-689-5970
Practice Address - Street 1:1600 W COLLEGE ST STE 130
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3575
Practice Address - Country:US
Practice Address - Phone:214-689-7806
Practice Address - Fax:214-689-5970
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228749207R00000X
TXN2253207RI0200X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207526901Medicaid
8L17473Medicare PIN
TX8L17473Medicare PIN