1811019292 NPI number — DR. GEETHA D CHANDRASEKHAR M.D.

Table of content: DR. GEETHA D CHANDRASEKHAR M.D. (NPI 1811019292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811019292 NPI number — DR. GEETHA D CHANDRASEKHAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANDRASEKHAR
Provider First Name:
GEETHA
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811019292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7982 HONEYGO BLVD # 33
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21236-4919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-742-5474
Provider Business Mailing Address Fax Number:
410-510-1134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9106 PHILADELPHIA RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237-4329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-742-5474
Provider Business Practice Location Address Fax Number:
410-510-1134
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X , with the licence number:  D0056045 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112073900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com