Provider Demographics
NPI:1720040256
Name:JAIN, CHANDRIKA D (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRIKA
Middle Name:D
Last Name:JAIN
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:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:
Practice Address - Street 1:44 CENTRAL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BERLIN
Practice Address - State:MA
Practice Address - Zip Code:01503-1225
Practice Address - Country:US
Practice Address - Phone:978-838-2330
Practice Address - Fax:978-838-2087
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF17792Medicare UPIN