Provider Demographics
NPI:1689742488
Name:CHADDHA, SUBHASH (MD)
Entity Type:Individual
Prefix:
First Name:SUBHASH
Middle Name:
Last Name:CHADDHA
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 1:52 BEACH ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6017
Mailing Address - Country:US
Mailing Address - Phone:203-255-4453
Mailing Address - Fax:203-254-2499
Practice Address - Street 1:52 BEACH ROAD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6017
Practice Address - Country:US
Practice Address - Phone:203-255-4453
Practice Address - Fax:203-254-2499
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT160392080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0826903OtherCIGNA HEALTHCARE PLANS
4273114OtherAETNA HEALTH
ZP174OtherOXFORD HEALTH PLANS
2162200OtherAETNA HEALTH
000270OtherHEALTH NET
49935OtherUNITED HEALTH CARE