Provider Demographics
NPI:1255495123
Name:NADIPURAM, CHANDRIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRIKA
Middle Name:
Last Name:NADIPURAM
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 1:14 AUTUMN LN
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7747
Mailing Address - Country:US
Mailing Address - Phone:848-863-6621
Mailing Address - Fax:
Practice Address - Street 1:14 AUTUMN LN
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-7747
Practice Address - Country:US
Practice Address - Phone:848-863-6621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0505172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ451918C2DOtherLEGACYID/SFX
NJNA451918OtherMEDITRAKID
NJ2084P0800XOtherTAXONOMY
NJ451918C2DOtherLEGACYID/SFX