Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 01050624A | IN |
N | 2080P0208X | Pediatric Infectious Diseases | 01050624A | IN |
NPI | 1073593034 |
---|---|
Provider Name | Chandrama Chakrabarti |
First Address | Terre Haute, IN 47802 |
Second Address | Terre Haute, IN 47802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 12/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000244694 | BLUE CROSS PROVIDER # (01) | |
200414010 | (05) | IN |
I45820 | (02) |