Provider Demographics
NPI:1437324753
Name:KATHIRAVAN, CHANDRAKALA (MD)
Entity Type:Individual
Prefix:
First Name:CHANDRAKALA
Middle Name:
Last Name:KATHIRAVAN
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 1:1902A MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-4605
Mailing Address - Country:US
Mailing Address - Phone:302-656-7108
Mailing Address - Fax:
Practice Address - Street 1:1902A MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4605
Practice Address - Country:US
Practice Address - Phone:302-656-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00101962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry