Provider Demographics
NPI:1285920405
Name:CHEATHAM, NIRMALA NANDINI (MD)
Entity type:Individual
Prefix:
First Name:NIRMALA
Middle Name:NANDINI
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIRMALA
Other - Middle Name:NANDINI
Other - Last Name:MAHARAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 847522
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7522
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:2026 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-5822
Practice Address - Country:US
Practice Address - Phone:903-586-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2159207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370083301Medicaid
TX75-1976930-005OtherTRICARE
TX8GM804OtherBCBS
TXP01812509OtherRAIL ROAD MEDICARE