Provider Demographics
NPI:1417091489
Name:ARCHANA CHANDRA, MD, PA
Entity Type:Organization
Organization Name:ARCHANA CHANDRA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARCHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-353-8616
Mailing Address - Street 1:502 N VALLEY PKWY
Mailing Address - Street 2:STE 1
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3437
Mailing Address - Country:US
Mailing Address - Phone:972-353-8616
Mailing Address - Fax:972-353-5352
Practice Address - Street 1:502 N VALLEY PKWY
Practice Address - Street 2:STE 1
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3437
Practice Address - Country:US
Practice Address - Phone:972-353-8616
Practice Address - Fax:972-353-5352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8724207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4156685OtherBLUELINK
8P9090OtherBCBS
TX1442063-14Medicaid
5635389OtherAETNA
BC4719451OtherDEA
G55685Medicare UPIN
8C2744Medicare ID - Type Unspecified