Provider Demographics
NPI:1962998401
Name:ALVA, NISHITH NAVEENA CHANDRA (MD)
Entity type:Individual
Prefix:
First Name:NISHITH
Middle Name:NAVEENA CHANDRA
Last Name:ALVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 INTEGRIS PKWY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-8864
Mailing Address - Country:US
Mailing Address - Phone:405-657-3120
Mailing Address - Fax:405-657-3122
Practice Address - Street 1:4801 INTEGRIS PKWY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-8864
Practice Address - Country:US
Practice Address - Phone:405-657-3120
Practice Address - Fax:405-657-3122
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018013129207R00000X
OK38715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine