Provider Demographics
NPI:1083098214
Name:MIDLOTHIAN PRIMARY CARE DOCTORS PLLC
Entity Type:Organization
Organization Name:MIDLOTHIAN PRIMARY CARE DOCTORS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:PANNABEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NANGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:871-477-5884
Mailing Address - Street 1:661 E MAIN ST
Mailing Address - Street 2:SUITE #900
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-3340
Mailing Address - Country:US
Mailing Address - Phone:817-477-5884
Mailing Address - Fax:
Practice Address - Street 1:221 REGENCY PARKWAY
Practice Address - Street 2:SUITE 125
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-0000
Practice Address - Country:US
Practice Address - Phone:817-477-5884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451810Medicare PIN