Provider Demographics
NPI:1699958579
Name:NANGHA, PANNABEN H (MD)
Entity type:Individual
Prefix:
First Name:PANNABEN
Middle Name:H
Last Name:NANGHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:221 REGENCY PKWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5165
Mailing Address - Country:US
Mailing Address - Phone:817-477-5884
Mailing Address - Fax:817-453-8091
Practice Address - Street 1:221 REGENCY PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5165
Practice Address - Country:US
Practice Address - Phone:817-477-5884
Practice Address - Fax:817-453-8091
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2015-11-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN8959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01036446OtherRAILROAD MEDICARE
TX305741602Medicaid
TX451840ZRVTMedicare PIN
TXTXB147361Medicare PIN