Provider Demographics
NPI:1669409108
Name:CHOCKALINGAM, ANAND (MD)
Entity type:Individual
Prefix:
First Name:ANAND
Middle Name:
Last Name:CHOCKALINGAM
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 1:3100 MACCORKLE AVE SE STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1215
Mailing Address - Country:US
Mailing Address - Phone:304-388-8200
Mailing Address - Fax:304-388-7010
Practice Address - Street 1:3100 MACCORKLE AVE SE STE 101
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1215
Practice Address - Country:US
Practice Address - Phone:304-388-8200
Practice Address - Fax:304-388-7010
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006012794207RC0000X
WV21460207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201421500Medicaid
MO209073OtherBLUE SHIELD
MO751228OtherHEALTHLINK
MO209073OtherBLUE CHOICE
MOI05221Medicare UPIN
MOP00415536Medicare PIN