Provider Demographics
NPI:1922502533
Name:CHATHA, SANDEEP KAUR (MD)
Entity Type:Individual
Prefix:
First Name:SANDEEP
Middle Name:KAUR
Last Name:CHATHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDEEP
Other - Middle Name:KAUR
Other - Last Name:RANDHAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 932909
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0026
Mailing Address - Country:US
Mailing Address - Phone:330-854-4281
Mailing Address - Fax:
Practice Address - Street 1:2839 COPLEY RD
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-2154
Practice Address - Country:US
Practice Address - Phone:330-666-2022
Practice Address - Fax:330-665-9659
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.142981CTR207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program