Provider Demographics
NPI:1639143852
Name:CHAIDARUN, SUSHELA S (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:SUSHELA
Middle Name:S
Last Name:CHAIDARUN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:SUSHELA
Other - Middle Name:
Other - Last Name:SONGTANIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC ENDOCRINOLOGY SECTION, DEPT OF MEDICINE
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-8630
Mailing Address - Fax:603-650-2240
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC ENDOCRINOLOGY SECTION, DEPT OF MEDICINE
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-8630
Practice Address - Fax:603-650-2240
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14189207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00053600OtherRAIL ROAD MEDICARE
OR299840Medicaid
VT1015905Medicaid
WA172221OtherL&I
WA8364564Medicaid
NH30208311Medicaid
NH30208311Medicaid
WAGAB38194Medicare PIN
WA172221OtherL&I
OR299840Medicaid