Provider Demographics
NPI:1962477133
Name:CHAVDA, GEETA S (MD)
Entity Type:Individual
Prefix:
First Name:GEETA
Middle Name:S
Last Name:CHAVDA
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 1:1739 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1991
Mailing Address - Country:US
Mailing Address - Phone:270-881-1411
Mailing Address - Fax:270-881-4730
Practice Address - Street 1:1739 CANTON ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1991
Practice Address - Country:US
Practice Address - Phone:270-881-1411
Practice Address - Fax:270-881-4730
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64051329Medicaid
KY64051329Medicaid
KY0994801Medicare ID - Type Unspecified