Provider Demographics
NPI:1922008366
Name:BAPNA, CHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:
Last Name:BAPNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHANDRA
Other - Middle Name:PRAKASH
Other - Last Name:BAPNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5106 N ARMENIA AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1433
Mailing Address - Country:US
Mailing Address - Phone:813-931-2366
Mailing Address - Fax:813-936-8886
Practice Address - Street 1:5106 N ARMENIA AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1433
Practice Address - Country:US
Practice Address - Phone:813-931-2366
Practice Address - Fax:813-936-8886
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0068445OtherSTATE LIC
FL201223OtherAMERIGROUP
FL593351224OtherTAX ID
FL110150380OtherRR MCARE
FL246331OtherAVMED
1922008366OtherNPPES
1114927027OtherNPPES - CORPORATE
FL28453OtherBCBS
FL379359100Medicaid
FL593351224OtherTAX ID
FL379359100Medicaid