Provider Demographics
NPI:1689853327
Name:HARISH CHANDNA,MD PA
Entity Type:Organization
Organization Name:HARISH CHANDNA,MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PYHSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HARISH
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHANDNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:361-580-2200
Mailing Address - Street 1:2104 PATTERSON DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5639
Mailing Address - Country:US
Mailing Address - Phone:361-580-2200
Mailing Address - Fax:361-580-2201
Practice Address - Street 1:2104 PATTERSON DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5639
Practice Address - Country:US
Practice Address - Phone:361-580-2200
Practice Address - Fax:361-580-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6546207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154291201Medicaid
TXG19797Medicare UPIN
TX00251UMedicare PIN