Provider Demographics
NPI:1831131499
Name:KATTA, CHANDRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:M
Last Name:KATTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5718 FIR LANE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-8122
Mailing Address - Country:US
Mailing Address - Phone:337-478-8555
Mailing Address - Fax:
Practice Address - Street 1:7414 SUMRALL DR
Practice Address - Street 2:SUITE C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70812-1240
Practice Address - Country:US
Practice Address - Phone:225-448-2937
Practice Address - Fax:225-246-8936
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP0016X
LA08484R2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4Q235Medicare PIN