Provider Demographics
NPI:1982682050
Name:PABLA, CHARNJIT S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARNJIT
Middle Name:S
Last Name:PABLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3640 NEW VISION DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1717
Mailing Address - Country:US
Mailing Address - Phone:260-482-4440
Mailing Address - Fax:260-482-4442
Practice Address - Street 1:2200 RANDALLIA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4638
Practice Address - Country:US
Practice Address - Phone:260-373-4000
Practice Address - Fax:260-482-4442
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047177207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200216290Medicaid
OH2617421Medicaid
IN000000380603OtherANTHEM
MI104874712Medicaid
000000033413OtherMPLAN
000000033413OtherMPLAN
INH07876Medicare UPIN
P00268251Medicare ID - Type UnspecifiedRR MEDICARE