Healthcare Provider Details

I. General information

NPI: 1942484084
Provider Name (Legal Business Name): PAULA LUCINE CHAKERIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 HAYNES ST
MANCHESTER CT
06040-4131
US

IV. Provider business mailing address

307 GRISSOM RD
MANCHESTER CT
06042-2222
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-6959
  • Fax: 203-739-6959
Mailing address:
  • Phone: 203-739-6959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number048388
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number048388
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: