Provider Demographics
NPI:1952485740
Name:CHELLIAH, NOAH N (MD)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:N
Last Name:CHELLIAH
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 1:1191 SOUTH COLUMBIA ROAD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201
Mailing Address - Country:US
Mailing Address - Phone:701-780-2000
Mailing Address - Fax:701-746-1663
Practice Address - Street 1:1191 SOUTH COLUMBIA ROAD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-780-2000
Practice Address - Fax:701-746-1663
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45526207RC0000X
MOR7H383207RC0000X
ND4722207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D25795Medicare UPIN
NDN19751Medicare PIN