Provider Demographics
NPI:1073878716
Name:NANGHA MD PLLC
Entity Type:Organization
Organization Name:NANGHA MD PLLC
Other - Org Name:MANSFIELD PEDIATRIC CARE DOCTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAITANYA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHAVDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-207-4805
Mailing Address - Street 1:309 REGENCY PKWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5165
Mailing Address - Country:US
Mailing Address - Phone:817-477-5884
Mailing Address - Fax:877-613-9101
Practice Address - Street 1:309 REGENCY PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5165
Practice Address - Country:US
Practice Address - Phone:817-477-5884
Practice Address - Fax:877-613-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8773208000000X
TXN8959261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty