Provider Demographics
NPI:1972864486
Name:PANNABEN H NANGHA MD PLLC
Entity Type:Organization
Organization Name:PANNABEN H NANGHA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PANNABEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:NANGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-477-5884
Mailing Address - Street 1:221 REGENCY PKWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5165
Mailing Address - Country:US
Mailing Address - Phone:817-477-5884
Mailing Address - Fax:817-453-8091
Practice Address - Street 1:221 REGENCY PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5165
Practice Address - Country:US
Practice Address - Phone:817-477-5884
Practice Address - Fax:817-453-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8959261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX309379101Medicaid
TXTXB160043Medicare PIN