Provider Demographics
NPI:1912960618
Name:CHECHANI, VIJAY (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:
Last Name:CHECHANI
Suffix:
Gender:M
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 2055
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-2055
Mailing Address - Country:US
Mailing Address - Phone:575-627-3319
Mailing Address - Fax:575-622-1720
Practice Address - Street 1:1717 W 2ND ST STE 172
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-2027
Practice Address - Country:US
Practice Address - Phone:575-627-3319
Practice Address - Fax:575-622-1720
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM9227207RS0012X, 207RP1001X, 207RC0200X
NM9227NM207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000E3271Medicaid
E24180Medicare UPIN
NM47798755ZWMedicare PIN
NMNM300391Medicare PIN
NME24180Medicare UPIN