Provider Demographics
NPI:1740231786
Name:SADDY, CHANCHAL R (MD)
Entity Type:Individual
Prefix:
First Name:CHANCHAL
Middle Name:R
Last Name:SADDY
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-9960
Mailing Address - Fax:704-384-9965
Practice Address - Street 1:10514 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8405
Practice Address - Country:US
Practice Address - Phone:704-384-9960
Practice Address - Fax:704-384-9965
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601711207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891029JMedicaid
NC891029JMedicaid
NC2231488DMedicare PIN
NC2231488BMedicare PIN