Provider Demographics
NPI:1578521381
Name:CHARY, KANDALA R (MD)
Entity Type:Individual
Prefix:DR
First Name:KANDALA
Middle Name:R
Last Name:CHARY
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 1:221 STERLING FARMS DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3609
Mailing Address - Country:US
Mailing Address - Phone:731-668-4337
Mailing Address - Fax:731-661-0124
Practice Address - Street 1:221 STERLING FARMS DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3609
Practice Address - Country:US
Practice Address - Phone:731-668-4337
Practice Address - Fax:731-661-0124
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000012441174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00126817Medicaid
3178684Medicare ID - Type Unspecified
B03826Medicare UPIN