Provider Demographics
NPI:1972283208
Name:MAHABAL, CHATRAM (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHATRAM
Middle Name:
Last Name:MAHABAL
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 NORWICH NEW LONDON TPKE STE 2
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-2518
Mailing Address - Country:US
Mailing Address - Phone:860-477-7072
Mailing Address - Fax:
Practice Address - Street 1:88 NORWICH NEW LONDON TPKE STE 2
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-2518
Practice Address - Country:US
Practice Address - Phone:860-477-7072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12185207RN0300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology