Provider Demographics
NPI:1962848069
Name:RAJENDRA, CHATHRUCKAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHATHRUCKAN
Middle Name:
Last Name:RAJENDRA
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:UCSF - DEPARTMENT OF PEDIATRICS
Mailing Address - Street 2:550 16TH ST. 4TH FL BOX 0110
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-9415
Mailing Address - Country:US
Mailing Address - Phone:415-476-2981
Mailing Address - Fax:
Practice Address - Street 1:300 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3816
Practice Address - Country:US
Practice Address - Phone:516-562-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1417822080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology