1720099765 NPI number — ACHI P CHARY MD

Table of content: ACHI P CHARY MD (NPI 1720099765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720099765 NPI number — ACHI P CHARY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARY
Provider First Name:
ACHI
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHARY
Provider Other First Name:
ACHI
Provider Other Middle Name:
PANDURANGA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720099765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6006 RUNNING CREEK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77345-1966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-312-5006
Provider Business Mailing Address Fax Number:
281-852-7579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22999 U.S. HWY. 59N.
Provider Second Line Business Practice Location Address:
STE 232
Provider Business Practice Location Address City Name:
KINGWOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-312-5006
Provider Business Practice Location Address Fax Number:
281-852-7579
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  L0075 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: L0075 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 044950601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0013JU . This is a "BLUECROSS/BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 460499364 . This is a "TAX ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1-119727 . This is a "TMLT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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