Provider Demographics
NPI:1821198177
Name:NETRAVALI, CHITRA ARUN (MD)
Entity Type:Individual
Prefix:MRS
First Name:CHITRA
Middle Name:ARUN
Last Name:NETRAVALI
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 1:10 BYRON COURT
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2250
Mailing Address - Country:US
Mailing Address - Phone:908-654-7763
Mailing Address - Fax:
Practice Address - Street 1:110 WILLIAM STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-733-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03463000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1106708Medicaid
NJ1106708Medicaid
NJ1106708Medicaid