MEDICARE: SUKUMAR M CHAPA 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	MD038943L	PA
2	208600000X	Surgery Physician	MD038943L	PA

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	:	1871555904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUKUMAR M CHAPA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 447
Second Line	:
City	:	DU BOIS
State	:	PA
Zip	:	15801-0447
Country	:	US
Telephone Number	:	814-849-5151
Fax Number	:	814-849-9624

Provider Business Practice Location Address
First Line	:	240 ALLEGHENY BLVD
Second Line	:	STE A
City	:	BROOKVILLE
State	:	PA
Zip	:	15825-2323
Country	:	US
Telephone Number	:	814-849-5151
Fax Number	:	814-849-9624

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	06/16/2011

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