Provider Demographics
NPI:1932232576
Name:OM P. CHAURASIA, MD, INC.
Entity Type:Organization
Organization Name:OM P. CHAURASIA, MD, INC.
Other - Org Name:PACIFIC GASTROENTEROLOGY MEDICAL ASSOCIATES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OM
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHAURASIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-365-8836
Mailing Address - Street 1:26421 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 140A
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8564
Mailing Address - Country:US
Mailing Address - Phone:949-365-8836
Mailing Address - Fax:949-365-8837
Practice Address - Street 1:26421 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 140A
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8564
Practice Address - Country:US
Practice Address - Phone:949-365-8836
Practice Address - Fax:949-365-8837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14853Medicare PIN