Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 35-050960 | OH |
NPI | 1255307369 |
---|---|
Provider Name | Alaknanda S Chandurkar |
First Address | Cleveland, OH 44194-1036 |
Second Address | Cleveland, OH 44111-5612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 11/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000363387 | ANTHEM (01) | OH |
0654733 | (05) | OH |
F11011 | (02) | OH |