Provider Demographics
NPI:1003867607
Name:CHENNAPRAGADA, KAUSALYA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAUSALYA
Middle Name:
Last Name:CHENNAPRAGADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAUSALYA
Other - Middle Name:CHENNAPRAGADA
Other - Last Name:BHASKARABHATLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1031 MCBRIDE AVE
Mailing Address - Street 2:SUITE D208
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2559
Mailing Address - Country:US
Mailing Address - Phone:973-812-1010
Mailing Address - Fax:
Practice Address - Street 1:1031 MCBRIDE AVE
Practice Address - Street 2:SUITE D208
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2559
Practice Address - Country:US
Practice Address - Phone:973-812-1010
Practice Address - Fax:973-200-0120
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO71431208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H53175Medicare UPIN