Provider Demographics
NPI:1245596006
Name:CHANDRATARA, PA
Entity Type:Organization
Organization Name:CHANDRATARA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:SWATI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLENDULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-213-6400
Mailing Address - Street 1:4500 HILLCREST RD STE 115
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5418
Mailing Address - Country:US
Mailing Address - Phone:469-213-6400
Mailing Address - Fax:469-213-6473
Practice Address - Street 1:4500 HILLCREST RD STE 115
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5418
Practice Address - Country:US
Practice Address - Phone:469-213-6400
Practice Address - Fax:469-213-6473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9542103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX318504OtherMEDICARE PTAN
TX363043OtherMEDICARE PTAN