Healthcare Provider Details

I. General information

NPI: 1437414307
Provider Name (Legal Business Name): SAMARTH SURESH CHITTARGI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 WEST LN
STOCKTON CA
95210-3377
US

IV. Provider business mailing address

6954 WHALERS WAY
STOCKTON CA
95219-8808
US

V. Phone/Fax

Practice location:
  • Phone: 209-476-2080
  • Fax:
Mailing address:
  • Phone: 617-901-7745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC167327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: