Provider Demographics
NPI:1205804820
Name:CHATRA, SHUBHA R (MD)
Entity type:Individual
Prefix:DR
First Name:SHUBHA
Middle Name:R
Last Name:CHATRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2000 BROOKSIDE DR
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4627
Mailing Address - Country:US
Mailing Address - Phone:423-857-5905
Mailing Address - Fax:423-857-5904
Practice Address - Street 1:2000 BROOKSIDE DR
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4627
Practice Address - Country:US
Practice Address - Phone:423-857-5905
Practice Address - Fax:423-857-5904
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN36586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1205804820Medicaid
TNQ002690Medicaid
TNP01042347OtherRR MEDICARE
TN38747501Medicaid
KY64060684Medicaid
TN3874752Medicaid
NC7906546Medicaid
KY64060684Medicaid
NC7906546Medicaid