Provider Demographics
NPI:1326036450
Name:SETHI-DIHENIA, CHANDA S (MD)
Entity Type:Individual
Prefix:
First Name:CHANDA
Middle Name:S
Last Name:SETHI-DIHENIA
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:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-3150
Mailing Address - Fax:806-743-3168
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430
Practice Address - Country:US
Practice Address - Phone:806-743-3150
Practice Address - Fax:806-743-3168
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3157208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87832ZOtherHMO BLUE
TX124233106Medicaid
NM37070OtherPRESBYTERIAN COMMERCIAL
TX100150107OtherFIRSTCARE COMMERCIAL
NM66744Medicaid
TX8B2605OtherBC/BS
A006OtherTRIWEST
OK200042450AMedicaid
TX100150105OtherFIRSTCARE COMMERCIAL
TX100150106Medicaid
TX124233106Medicaid
TX100150107OtherFIRSTCARE COMMERCIAL
NM66744Medicaid