Provider Demographics
NPI:1962465740
Name:VORA, CHETNA SHAILESH (MD)
Entity Type:Individual
Prefix:
First Name:CHETNA
Middle Name:SHAILESH
Last Name:VORA
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:PO BOX 851
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:AR
Mailing Address - Zip Code:71744-0851
Mailing Address - Country:US
Mailing Address - Phone:870-798-3515
Mailing Address - Fax:870-798-2005
Practice Address - Street 1:253 SOUTH CONCORD
Practice Address - Street 2:
Practice Address - City:STRONG
Practice Address - State:AR
Practice Address - Zip Code:71765
Practice Address - Country:US
Practice Address - Phone:870-797-7620
Practice Address - Fax:870-797-2459
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-4132208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE69198Medicare UPIN
AR54388Medicare ID - Type Unspecified