Provider Demographics
NPI:1790946663
Name:CHIRLA, SUJALA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUJALA
Middle Name:
Last Name:CHIRLA
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 1:695 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7200
Mailing Address - Country:US
Mailing Address - Phone:908-688-6565
Mailing Address - Fax:908-688-3161
Practice Address - Street 1:695 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7200
Practice Address - Country:US
Practice Address - Phone:908-688-6565
Practice Address - Fax:908-688-3161
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09139900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116065OtherPA BLUE SHIELD
PA102340407Medicaid
PA6909792OtherAETNA
2116065OtherPA BLUE SHIELD