Provider Demographics
NPI:1790051597
Name:EZHAPILLI CHENNAN, SAJEEV RAJAN (MD)
Entity Type:Individual
Prefix:
First Name:SAJEEV
Middle Name:RAJAN
Last Name:EZHAPILLI CHENNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 ALAMEDA AVE DEPT OF
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2705
Mailing Address - Country:US
Mailing Address - Phone:915-545-8823
Mailing Address - Fax:915-545-9799
Practice Address - Street 1:4815 ALAMEDA AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2705
Practice Address - Country:US
Practice Address - Phone:915-545-8823
Practice Address - Fax:915-545-9799
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS10882085R0202X
TX463752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty