Provider Demographics
NPI:1477529360
Name:SARKAR, CHITTO P (DO)
Entity Type:Individual
Prefix:DR
First Name:CHITTO
Middle Name:P
Last Name:SARKAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7830 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-2322
Mailing Address - Country:US
Mailing Address - Phone:772-871-9025
Mailing Address - Fax:772-871-0119
Practice Address - Street 1:7830 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-2322
Practice Address - Country:US
Practice Address - Phone:772-871-9025
Practice Address - Fax:772-871-0119
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005705204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050862400Medicaid
FL80231Medicare ID - Type Unspecified
FL050862400Medicaid