Provider Demographics
NPI:1720026693
Name:CHA, GLORIA H (MD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:H
Last Name:CHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:251 WESTPARK WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3742
Mailing Address - Country:US
Mailing Address - Phone:682-236-3656
Mailing Address - Fax:682-236-6667
Practice Address - Street 1:251 WESTPARK WAY STE 210
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3742
Practice Address - Country:US
Practice Address - Phone:682-236-3656
Practice Address - Fax:682-236-6667
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG90711Medicare UPIN
TX424121YKQLMedicare PIN
TX424121YKP5Medicare PIN