Provider Demographics
NPI:1134149545
Name:KAMATH, CHANDRAKALA Y (MD)
Entity type:Individual
Prefix:DR
First Name:CHANDRAKALA
Middle Name:Y
Last Name:KAMATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 KINGSTON TER
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-9603
Mailing Address - Country:US
Mailing Address - Phone:609-921-6992
Mailing Address - Fax:609-921-2847
Practice Address - Street 1:26 KINGSTON TER
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-9603
Practice Address - Country:US
Practice Address - Phone:609-921-6992
Practice Address - Fax:609-921-2847
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ36627174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD96848Medicare UPIN
NJKA456514Medicare ID - Type Unspecified