Provider Demographics
NPI:1326501909
Name:POTARAJU, CHANDANA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDANA
Middle Name:
Last Name:POTARAJU
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 1:4166 BRINSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7926
Mailing Address - Country:US
Mailing Address - Phone:614-578-0755
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL RD STE 201
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-8814
Practice Address - Country:US
Practice Address - Phone:631-475-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program