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1205804820

NPI Code Detail

MEDICARE: DR. SHUBHA R CHATRA MD

MEDICARE: DR. SHUBHA R CHATRA MD

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	207R00000X	Internal Medicine Physician	36586	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01042347	OTHER	TN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205804820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHUBHA R CHATRA MD

Provider Business Mailing Address
First Line	:	2000 BROOKSIDE DR
Second Line	:	THIRD FLOOR
City	:	KINGSPORT
State	:	TN
Zip	:	37660-4627
Country	:	US
Telephone Number	:	423-857-5905
Fax Number	:	423-857-5904

Provider Business Practice Location Address
First Line	:	2000 BROOKSIDE DR
Second Line	:	THIRD FLOOR
City	:	KINGSPORT
State	:	TN
Zip	:	37660-4627
Country	:	US
Telephone Number	:	423-857-5905
Fax Number	:	423-857-5904

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	12/29/2014

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Directions to “ DR. SHUBHA R CHATRA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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