MEDICARE: DR. BALACHANDRA RAO CHEKKA 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	208000000X	Pediatrics Physician	MD038253L	PA

General Provider Information

NPI Number	:	1770550063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BALACHANDRA RAO CHEKKA M.D.

Provider Business Mailing Address
First Line	:	1611 PEACH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16501-2109
Country	:	US
Telephone Number	:	814-454-2891
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 PEACH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16501-2109
Country	:	US
Telephone Number	:	814-454-2891
Fax Number	:

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

Provider Enumeration Date	:	03/05/2006
Last Update Date	:	07/08/2007

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