Provider Demographics
NPI:1679752075
Name:B. V. CHANDRAMOULI, M..D., INC.
Entity Type:Organization
Organization Name:B. V. CHANDRAMOULI, M..D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:B
Authorized Official - Middle Name:V
Authorized Official - Last Name:CHANDRAMOULI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-244-4471
Mailing Address - Street 1:1555 EAST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1153
Mailing Address - Country:US
Mailing Address - Phone:530-244-4471
Mailing Address - Fax:530-244-1407
Practice Address - Street 1:1555 EAST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1153
Practice Address - Country:US
Practice Address - Phone:530-244-4471
Practice Address - Fax:530-244-1407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A521990207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060070712OtherRAILROAD MEDICARE
CAZZZ25086ZMedicare PIN