Provider Demographics
NPI:1912045220
Name:CHADDA, PRABHUJEET (MD)
Entity Type:Individual
Prefix:
First Name:PRABHUJEET
Middle Name:
Last Name:CHADDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14027 MEMORIAL DR STE 252
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-6826
Mailing Address - Country:US
Mailing Address - Phone:832-203-7640
Mailing Address - Fax:832-834-6409
Practice Address - Street 1:14027 MEMORIAL DR
Practice Address - Street 2:#252
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079
Practice Address - Country:US
Practice Address - Phone:281-412-2494
Practice Address - Fax:281-412-2495
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG58142080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128160204Medicaid
TX81K192Medicare PIN
E77846Medicare UPIN