Healthcare Provider Details

I. General information

NPI: 1871591578
Provider Name (Legal Business Name): VIJAY KUMAR CHHABRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 BOSTON POST RD SUITE 100
MILFORD CT
06460-3537
US

IV. Provider business mailing address

849 BOSTON POST RD SUITE 100
MILFORD CT
06460-3537
US

V. Phone/Fax

Practice location:
  • Phone: 203-882-9608
  • Fax:
Mailing address:
  • Phone: 203-882-9608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number041905
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: