Provider Demographics
NPI:1366829301
Name:CHOLAMANAUNNIKRISHNAN, DILEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:DILEEP
Middle Name:
Last Name:CHOLAMANAUNNIKRISHNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DILEEP
Other - Middle Name:C
Other - Last Name:UNNIKRISHNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:300 2ND AVE # G417
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6303
Mailing Address - Country:US
Mailing Address - Phone:207-307-9165
Mailing Address - Fax:
Practice Address - Street 1:300 2ND AVE # G417
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6303
Practice Address - Country:US
Practice Address - Phone:207-307-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT08186918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine