Provider Demographics
NPI:1740286236
Name:CHAKRAVARTY, JYOTI (MD)
Entity type:Individual
Prefix:
First Name:JYOTI
Middle Name:
Last Name:CHAKRAVARTY
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 1:3140 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-2920
Mailing Address - Country:US
Mailing Address - Phone:419-537-5111
Mailing Address - Fax:419-537-5131
Practice Address - Street 1:3140 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-2920
Practice Address - Country:US
Practice Address - Phone:419-537-5111
Practice Address - Fax:419-537-5131
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040779207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00580OtherPARAMOUNT
OH4095527OtherAETNA
OH0436120Medicaid
OH000000203479OtherANTHEM
OHCH0449623Medicare ID - Type Unspecified
OHA77650Medicare UPIN