Provider Demographics
NPI:1073593034
Name:CHAKRABARTI, CHANDRAMA (MD)
Entity Type:Individual
Prefix:
First Name:CHANDRAMA
Middle Name:
Last Name:CHAKRABARTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 SPRINGHILL JUNCTION
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802
Mailing Address - Country:US
Mailing Address - Phone:812-234-6053
Mailing Address - Fax:812-478-3416
Practice Address - Street 1:4525 SPRINGHILL JUNCTION
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802
Practice Address - Country:US
Practice Address - Phone:812-234-6053
Practice Address - Fax:812-478-3416
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050624A208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000244694OtherBLUE CROSS PROVIDER #
IN200414010Medicaid
I45820Medicare UPIN
IN200414010Medicaid