Provider Demographics
NPI:1437640950
Name:CHAKRAVARTTY, EESHA (MD)
Entity Type:Individual
Prefix:
First Name:EESHA
Middle Name:
Last Name:CHAKRAVARTTY
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 1:585 SCHENECTADY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1851
Mailing Address - Country:US
Mailing Address - Phone:718-363-6771
Mailing Address - Fax:
Practice Address - Street 1:18133 VENTURA BLVD STE 405
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3726
Practice Address - Country:US
Practice Address - Phone:424-315-0285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312067208M00000X
CAA193698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist