Provider Demographics
NPI:1104808765
Name:CHHIBBER, SUPARNA M (MD)
Entity type:Individual
Prefix:DR
First Name:SUPARNA
Middle Name:M
Last Name:CHHIBBER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:909 DAIRY ASHFORD ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5309
Mailing Address - Country:US
Mailing Address - Phone:281-493-3681
Mailing Address - Fax:281-456-2549
Practice Address - Street 1:1026 BLACKHAW ST STE 102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1002
Practice Address - Country:US
Practice Address - Phone:281-493-3681
Practice Address - Fax:281-589-1465
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2022-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM0376207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI25204Medicare UPIN