Provider Demographics
NPI:1134198013
Name:CHANDRA, ARCHANA (MD)
Entity type:Individual
Prefix:
First Name:ARCHANA
Middle Name:
Last Name:CHANDRA
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 1:502 N VALLEY PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3437
Mailing Address - Country:US
Mailing Address - Phone:972-353-8616
Mailing Address - Fax:972-353-5352
Practice Address - Street 1:502 N VALLEY PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3437
Practice Address - Country:US
Practice Address - Phone:972-353-8616
Practice Address - Fax:972-353-5352
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8724207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144206305Medicaid
TX144206306Medicaid
TX144206311Medicaid
TX81Y187OtherBCBS
TX144206304Medicaid
TX144206312Medicaid
TX144206307Medicaid
TX144206308Medicaid
TX144206309Medicaid
TX144206302Medicaid
TX144206301Medicaid
TX144206303Medicaid
TX144206313Medicaid
TX144206311Medicaid