Provider Demographics
NPI:1518935501
Name:CHAPLA, PRAVINCHANDRA G (MD)
Entity Type:Individual
Prefix:
First Name:PRAVINCHANDRA
Middle Name:G
Last Name:CHAPLA
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 1:1 OUTLET LN STE 380
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-7814
Mailing Address - Country:US
Mailing Address - Phone:570-398-1800
Mailing Address - Fax:570-398-3320
Practice Address - Street 1:1 OUTLET LN STE 380
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-7814
Practice Address - Country:US
Practice Address - Phone:570-398-1800
Practice Address - Fax:570-398-3320
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061865L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016696100001Medicaid
G57024Medicare UPIN
PA901311Medicare PIN