Provider Demographics
NPI:1972563302
Name:IRRI, CHAKRAPANI (MD)
Entity Type:Individual
Prefix:
First Name:CHAKRAPANI
Middle Name:
Last Name:IRRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 LANSING STREET
Mailing Address - Street 2:ATTN: C. MCLOUD
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021
Mailing Address - Country:US
Mailing Address - Phone:315-567-0455
Mailing Address - Fax:315-253-8693
Practice Address - Street 1:37 W. GARDEN STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1302
Practice Address - Country:US
Practice Address - Phone:315-253-6257
Practice Address - Fax:315-253-8693
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2020-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY209760208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01769713Medicaid