MEDICARE: DR. CHANNAPPA CHANDRA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD12337	TN
2	207X00000X	Orthopaedic Surgery Physician	MD12337	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4582070001	OTHER	TN	DMERC

General Provider Information

NPI Number	:	1073510509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANNAPPA CHANDRA M.D.

Provider Business Mailing Address
First Line	:	979 E 3RD ST
Second Line	:	SUITE C430
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-2136
Country	:	US
Telephone Number	:	423-624-6584
Fax Number	:	423-624-6588

Provider Business Practice Location Address
First Line	:	979 E 3RD ST
Second Line	:	SUITE C430
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-2136
Country	:	US
Telephone Number	:	423-624-6584
Fax Number	:	423-624-6588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	02/26/2013

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Directions to “ DR. CHANNAPPA CHANDRA M.D.” Practice Location

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