Provider Demographics
NPI:1750465712
Name:CHATTERJEE, SUDARSHAN (MD FACC)
Entity Type:Individual
Prefix:MR
First Name:SUDARSHAN
Middle Name:
Last Name:CHATTERJEE
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 E TRAPPER TRL
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4734
Mailing Address - Country:US
Mailing Address - Phone:909-398-1503
Mailing Address - Fax:909-398-4950
Practice Address - Street 1:4950 SAN BERNARDINO ST STE 208
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2328
Practice Address - Country:US
Practice Address - Phone:978-430-3082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53581207RC0000X
CAC43324207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
201274943OtherPRIVATE HEALTH SYSTEM
419452OtherUS FAMILY HEALTH
CAC43324OtherMEDICAL BOARD OF CALIFORNIA -DEPARTMENT OF CONSUMER AFFAIRS
302201063OtherEDS NH MEDICAID
31496OtherFALLON COMM HEALTH PLANS
981971OtherNETWORK HEALTH PLAN
0014180OtherNEIGHBORHOOD HEALTH PLAN
201274943OtherFIRST HEALTH
2500732OtherUNITED HEALTH CARE
J09303OtherBCBS OF MASS
2500732OtherEVERCARE
60560OtherCIGNA
053581OtherTUFTS HEALTH PLAN
0104615YPM01OtherANTHEM BLUE SHIELD
MA3057607Medicaid
61066OtherHARVARD PILGRIM
89673OtherAETNA USHC HMO ONLY
MA3057607Medicaid