Provider Demographics
NPI:1962504167
Name:CHIMPIRI, ANNAPURNESWARA RAO (MD)
Entity Type:Individual
Prefix:
First Name:ANNAPURNESWARA
Middle Name:RAO
Last Name:CHIMPIRI
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:HSC LEVEL 4 RM 120
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8460
Mailing Address - Country:US
Mailing Address - Phone:631-444-5400
Mailing Address - Fax:631-444-7538
Practice Address - Street 1:HSC L4 RM 120
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8460
Practice Address - Country:US
Practice Address - Phone:631-444-5400
Practice Address - Fax:631-444-7538
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251312085R0202X
GA0667682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52601605 002OtherBCBSGA
GA52601605 001OtherBCBSGA
GAP01171167OtherRAILROAD MEDICARE
GA003132709BMedicaid
GA003132709AMedicaid
GA202I301169Medicare PIN
246635511Medicare PIN