Provider Demographics
NPI:1073775417
Name:HANNAN CHAUGLE M.D.
Entity Type:Organization
Organization Name:HANNAN CHAUGLE M.D.
Other - Org Name:CENTRAL VALLEY CARDIO VASCULAR & THORACIC INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HANNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-975-8455
Mailing Address - Street 1:1401 SPANOS CT STE 125
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2814
Mailing Address - Country:US
Mailing Address - Phone:503-975-8455
Mailing Address - Fax:
Practice Address - Street 1:1401 SPANOS CT STE 125
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2814
Practice Address - Country:US
Practice Address - Phone:503-975-8455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97091208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty