Provider Demographics
NPI:1538303144
Name:CHANDRA, SRINIVASA RAMA (MD, DDS, FDSRCS)
Entity Type:Individual
Prefix:DR
First Name:SRINIVASA
Middle Name:RAMA
Last Name:CHANDRA
Suffix:
Gender:M
Credentials:MD, DDS, FDSRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 9TH AVE
Mailing Address - Street 2:4 WEST CLINIC, BOX-359893,
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2420
Mailing Address - Country:US
Mailing Address - Phone:206-744-3224
Mailing Address - Fax:206-744-2810
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:4 WEST CLINIC, BOX-359893,
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-744-3224
Practice Address - Fax:206-744-2810
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WA60478567204E00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access