MEDICARE: CHITRA V NADIMPALLI 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	207W00000X	Ophthalmology Physician	036069007	IL

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

General Provider Information

NPI Number	:	1306816616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHITRA V NADIMPALLI MD

Provider Business Mailing Address
First Line	:	3000 39TH ST
Second Line	:	SUITE 102
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5517
Country	:	US
Telephone Number	:	409-985-2569
Fax Number	:	409-985-2915

Provider Business Practice Location Address
First Line	:	3000 39TH ST
Second Line	:	SUITE 102
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5517
Country	:	US
Telephone Number	:	409-985-2569
Fax Number	:	409-985-2915

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	12/08/2010

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