Provider Demographics
NPI:1356558621
Name:CHAKRABARTY, INDRANEEL (MD)
Entity type:Individual
Prefix:MR
First Name:INDRANEEL
Middle Name:
Last Name:CHAKRABARTY
Suffix:
Gender:M
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:PO BOX 2680
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92593-2680
Mailing Address - Country:US
Mailing Address - Phone:951-501-4200
Mailing Address - Fax:951-900-3110
Practice Address - Street 1:31625 DE PORTOLA RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2770
Practice Address - Country:US
Practice Address - Phone:951-501-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100481207R00000X, 207RG0100X
MA232347208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist