Provider Demographics
NPI:1942214952
Name:CHANDRASHEKAR, PATALAPPA (MD)
Entity Type:Individual
Prefix:
First Name:PATALAPPA
Middle Name:
Last Name:CHANDRASHEKAR
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 1:44215 15TH ST W
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4014
Mailing Address - Country:US
Mailing Address - Phone:661-949-5273
Mailing Address - Fax:661-949-5475
Practice Address - Street 1:44215 15TH ST W
Practice Address - Street 2:SUITE 211
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4014
Practice Address - Country:US
Practice Address - Phone:661-949-5273
Practice Address - Fax:661-949-5475
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48344207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A483440OtherBLUE SHIELD
CAP00203364OtherRAILROAD MEDICARE
CA00A483440Medicaid
CAA48344Medicare PIN
CAP00203364OtherRAILROAD MEDICARE
CA00A483440Medicaid
CAWA48344DMedicare PIN