Provider Demographics
NPI:1437124484
Name:CHAVDA, SANJAY M (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:M
Last Name:CHAVDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 KENTON ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1981
Mailing Address - Country:US
Mailing Address - Phone:270-886-8840
Mailing Address - Fax:270-886-8869
Practice Address - Street 1:1739 CANTON ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1991
Practice Address - Country:US
Practice Address - Phone:270-881-1813
Practice Address - Fax:270-881-4730
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY33784207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64337843Medicaid
KY64337843Medicaid
KY0688602Medicare ID - Type Unspecified