Provider Demographics
NPI:1659368728
Name:CHAMAKURA, SANJAYANTH R (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAYANTH
Middle Name:R
Last Name:CHAMAKURA
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 1:1866 KELLER PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3763
Mailing Address - Country:US
Mailing Address - Phone:682-337-3810
Mailing Address - Fax:682-337-3817
Practice Address - Street 1:1866 KELLER PKWY STE B
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3763
Practice Address - Country:US
Practice Address - Phone:682-337-3810
Practice Address - Fax:682-337-3817
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0021207UN0901X, 207RI0011X, 207RC0000X, 207UN0901X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I068261Medicare PIN
GA003136350AMedicaid
CT004214459Medicaid
CTP3616073OtherOXFORD
CT043220OtherCONNECTICARE
CT2V6936OtherHEALTH NET
CT0007900670OtherAETNA
I31650Medicare UPIN
CT060001667Medicare ID - Type Unspecified
CT5835431OtherCIGNA
CT1255448155OtherGHMC GROUP NPI ID
CTC01373Medicare ID - Type UnspecifiedGHMC MEDICARE GRP ID
CT001432202Medicaid
CT010043220CT01OtherBCBS & BCFP