Provider Demographics
NPI:1891717385
Name:PEDDADA, CHITRA CHAUHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHITRA
Middle Name:CHAUHAN
Last Name:PEDDADA
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 1:6 ELM AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3120
Mailing Address - Country:US
Mailing Address - Phone:719-576-7006
Mailing Address - Fax:719-576-7981
Practice Address - Street 1:6 ELM AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3120
Practice Address - Country:US
Practice Address - Phone:719-576-7006
Practice Address - Fax:719-576-7981
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63174207R00000X
CO38207207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52223868Medicaid
COCO30695Medicare PIN
COG08632Medicare UPIN