Provider Demographics
NPI:1659363760
Name:CHAWLA, SURENDRA K (MD)
Entity Type:Individual
Prefix:DR
First Name:SURENDRA
Middle Name:K
Last Name:CHAWLA
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 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 3201A
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-714-1094
Mailing Address - Fax:860-714-8850
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 3201A
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-714-1094
Practice Address - Fax:860-714-8850
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT018076208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001180769Medicaid
CT780000035Medicare PIN
B39308Medicare UPIN