Provider Demographics
NPI:1457302143
Name:CHAKRABARTI, INDRANIL (MD)
Entity Type:Individual
Prefix:
First Name:INDRANIL
Middle Name:
Last Name:CHAKRABARTI
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 1:111 CHAMBERS HILL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-7304
Mailing Address - Country:US
Mailing Address - Phone:717-709-7922
Mailing Address - Fax:717-263-2055
Practice Address - Street 1:100 CHAMBERS HILL DR STE 200
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-7301
Practice Address - Country:US
Practice Address - Phone:717-709-7930
Practice Address - Fax:717-709-7931
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4275142084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA25-1716306OtherDEVON
PA25-1716306OtherHEALTHNET/TRICARE
PACH1979148OtherHIGHMARK BLUE SHIELD
PA102058497 0002 0003Medicaid
PA25-1716306OtherMULTIPLAN/PHCS
PA9296081OtherAETNA NON-HMO
PA1695953OtherAETNA HMO
PA25-1716306OtherINFORMED
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PAMD427514OtherLICENSE
PAP00432902OtherRAILROAD MEDICARE
PAG920-0067/233CCUOtherCAREFIRST
PA25-1716306OtherFIRST HEALTH
PA50072044OtherCAPITAL BLUECROSS
PA120420406OtherDEPT OF LABOR
PA25-1716306OtherINTERGROUP
PA867633OtherMEDICARE GROUP #
PAP00432902OtherRAILROAD MEDICARE
PA102058497 0002 0003Medicaid