Provider Demographics
NPI:1659605558
Name:CHIKKARAMANJEGOWDA, VIDYASHREE DARASAGUPPE (MD)
Entity Type:Individual
Prefix:DR
First Name:VIDYASHREE
Middle Name:DARASAGUPPE
Last Name:CHIKKARAMANJEGOWDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 FOUNTAIN CT
Mailing Address - Street 2:SUITE 225
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1888
Mailing Address - Country:US
Mailing Address - Phone:859-257-9317
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:ROOM HQ-101
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-257-1363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR22952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry