Provider Demographics
NPI:1932127685
Name:CHATTOPADHYAY, PRANAB K (MD)
Entity Type:Individual
Prefix:DR
First Name:PRANAB
Middle Name:K
Last Name:CHATTOPADHYAY
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:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:541 HISTORIC HWY 441-N
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-0037
Practice Address - Country:US
Practice Address - Phone:770-533-6521
Practice Address - Fax:770-535-7445
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48746207RN0300X
GA037777208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A487460Medicaid
GA000586275LMedicaid
GA1642909OtherWELLCARE
P00471396OtherMEDICARE RAILROAD
GA3673501OtherCIGNA