Provider Demographics
NPI:1033354873
Name:DE, CHITRADEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:CHITRADEEP
Middle Name:
Last Name:DE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 494127
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-4127
Mailing Address - Country:US
Mailing Address - Phone:941-212-2748
Mailing Address - Fax:941-328-8946
Practice Address - Street 1:3028 CARING WAY UNIT 4
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5300
Practice Address - Country:US
Practice Address - Phone:941-212-2748
Practice Address - Fax:941-328-8946
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125650207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty