Provider Demographics
NPI:1093763443
Name:SALEM, NAGARATINA CHANDRASEKARAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGARATINA
Middle Name:CHANDRASEKARAN
Last Name:SALEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAGARATINA
Other - Middle Name:C
Other - Last Name:SALEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2224 HARRISBURG LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-5514
Mailing Address - Country:US
Mailing Address - Phone:214-383-4400
Mailing Address - Fax:214-383-4403
Practice Address - Street 1:6850 TPC DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3128
Practice Address - Country:US
Practice Address - Phone:214-383-4400
Practice Address - Fax:214-383-4403
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4225208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AW552OtherBCBS
TX0011PJOtherBLUE CROSS BLUE SHIELD
TX201844383OtherTAX ID
TX111786303OtherTPI
TX205898695OtherTIN
TX205898695OtherTIN
TXG57285Medicare UPIN