Provider Demographics
NPI:1710160692
Name:CHAVDA, CHAITANYA B (MD)
Entity Type:Individual
Prefix:
First Name:CHAITANYA
Middle Name:B
Last Name:CHAVDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4927 LAKE RIDGE PKWY STE 148
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3087
Mailing Address - Country:US
Mailing Address - Phone:972-217-4203
Mailing Address - Fax:833-784-1531
Practice Address - Street 1:4927 LAKE RIDGE PKWY STE 148
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3087
Practice Address - Country:US
Practice Address - Phone:972-217-4203
Practice Address - Fax:833-784-1531
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN87732080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine