Provider Demographics
NPI:1467419010
Name:PANDIAN, CHELLIAH (MD)
Entity Type:Individual
Prefix:
First Name:CHELLIAH
Middle Name:
Last Name:PANDIAN
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 1:29 IVAN HILL ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2001
Mailing Address - Country:US
Mailing Address - Phone:860-423-8033
Mailing Address - Fax:860-423-8373
Practice Address - Street 1:29 IVAN HILL ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2001
Practice Address - Country:US
Practice Address - Phone:860-423-8033
Practice Address - Fax:860-423-8373
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001429837Medicaid
CTH30441Medicare UPIN
CT001429837Medicaid