Provider Demographics
NPI:1003845694
Name:CHOPRA, SHAILENDRA (MD)
Entity Type:Individual
Prefix:
First Name:SHAILENDRA
Middle Name:
Last Name:CHOPRA
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 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-4181
Mailing Address - Fax:859-258-4058
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-4181
Practice Address - Fax:859-258-4058
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY387522085B0100X, 2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4000501OtherMEDICARE LAB GROUP
GACB5773OtherRR MEDICARE GROUP
GAP00134375OtherRR MEDICARE PIN
KY64086101Medicaid
KY37903705OtherMEDICAID LAB GROUP
KY37903705OtherMEDICAID LAB GROUP
GACB5773OtherRR MEDICARE GROUP