Provider Demographics
NPI:1174024046
Name:CHITSWARA, CHANDRA L
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:L
Last Name:CHITSWARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3501
Mailing Address - Country:US
Mailing Address - Phone:570-622-6417
Mailing Address - Fax:
Practice Address - Street 1:208 S CENTRE ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3501
Practice Address - Country:US
Practice Address - Phone:570-622-6417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002883251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health