Provider Demographics
NPI:1326161878
Name:CHENNATTU, BINDU RAJEEV (MD)
Entity Type:Individual
Prefix:DR
First Name:BINDU
Middle Name:RAJEEV
Last Name:CHENNATTU
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 1:23 NORTON RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-1539
Mailing Address - Country:US
Mailing Address - Phone:203-459-8880
Mailing Address - Fax:
Practice Address - Street 1:3084 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4219
Practice Address - Country:US
Practice Address - Phone:203-371-0433
Practice Address - Fax:203-549-0919
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041993208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT250000365Medicare ID - Type UnspecifiedPHYSICIAN
CT114139Medicare UPIN