Provider Demographics
NPI:1942484084
Name:CHAKERIAN, PAULA LUCINE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:LUCINE
Last Name:CHAKERIAN
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 1:307 GRISSOM RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-2222
Mailing Address - Country:US
Mailing Address - Phone:203-739-6959
Mailing Address - Fax:
Practice Address - Street 1:71 HAYNES ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4131
Practice Address - Country:US
Practice Address - Phone:203-739-6959
Practice Address - Fax:203-739-6959
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT048388208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1563394C77OtherBNDD
CT1563394C77OtherBNDD