Provider Demographics
NPI:1275589145
Name:CHAKRAVARTHY, ASHISH K (MD)
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:K
Last Name:CHAKRAVARTHY
Suffix:
Gender:M
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:PO BOX 634706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1260 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37375-2303
Practice Address - Country:US
Practice Address - Phone:931-598-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN030804207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN18053OtherTLC TENNCARE
TN3728385Medicaid
TN3835180Medicaid
TN3835189Medicaid
TN4151492OtherBLUE CROSS
TN3835185Medicaid
TN3122069OtherBLUE CROSS
TNP00384383OtherMEDICARE RAILROAD
TN3728385Medicaid
TN3835180Medicare PIN
TN4151492OtherBLUE CROSS
TN3122069OtherBLUE CROSS
TN3835185Medicaid