Provider Demographics
NPI:1447588827
Name:CHELLAPPAN, CHANDRA PAVAI (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:PAVAI
Last Name:CHELLAPPAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11803 SOUTH FWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7012
Mailing Address - Country:US
Mailing Address - Phone:817-551-9339
Mailing Address - Fax:817-551-3757
Practice Address - Street 1:11803 SOUTH FWY STE 208
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7030
Practice Address - Country:US
Practice Address - Phone:817-551-9339
Practice Address - Fax:817-551-3757
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3552207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1447588827Medicaid