Provider Demographics
NPI:1245429398
Name:CHANDRASEKARAN, SRUTI
Entity Type:Individual
Prefix:
First Name:SRUTI
Middle Name:
Last Name:CHANDRASEKARAN
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 1:100 OLD YORK RD
Mailing Address - Street 2:APT 1221E
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3606
Mailing Address - Country:US
Mailing Address - Phone:267-240-7626
Mailing Address - Fax:
Practice Address - Street 1:100 OLD YORK RD
Practice Address - Street 2:APT 1221E
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3606
Practice Address - Country:US
Practice Address - Phone:267-240-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT189863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine