Provider Demographics
NPI:1457300535
Name:CHAKRABORTI, CHAYAN (MD)
Entity Type:Individual
Prefix:
First Name:CHAYAN
Middle Name:
Last Name:CHAKRABORTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 CADIZ ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-2830
Mailing Address - Country:US
Mailing Address - Phone:504-913-1274
Mailing Address - Fax:509-472-3758
Practice Address - Street 1:1430 TULANE AVE
Practice Address - Street 2:SL-16
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2632
Practice Address - Country:US
Practice Address - Phone:504-988-7518
Practice Address - Fax:509-472-3758
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026072208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1050822Medicaid
LAI38383Medicare UPIN
LA1050822Medicaid