Provider Demographics
NPI:1598882995
Name:CHELLIAH PANDIAN LLC
Entity Type:Organization
Organization Name:CHELLIAH PANDIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELLIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-423-8033
Mailing Address - Street 1:863 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4012
Mailing Address - Country:US
Mailing Address - Phone:860-633-7090
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH30441Medicare UPIN