Provider Demographics
NPI:1619361292
Name:CHINDAM, TIRUPATHI
Entity Type:Individual
Prefix:
First Name:TIRUPATHI
Middle Name:
Last Name:CHINDAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8731 KILPECK CT
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-5131
Mailing Address - Country:US
Mailing Address - Phone:909-800-5350
Mailing Address - Fax:
Practice Address - Street 1:2715 DOGTOWN RD
Practice Address - Street 2:ENVOY AT THE MEADOWS
Practice Address - City:GOOCHLAND
Practice Address - State:VA
Practice Address - Zip Code:23063-2424
Practice Address - Country:US
Practice Address - Phone:804-556-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist