Healthcare Provider Details

I. General information

NPI: 1235399718
Provider Name (Legal Business Name): CHALEOMARI KORNANDAKIETI TAPANEYA-OLARN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US DEPT OFSTATE M/MED/QI, SA-1
WASHINGTON DC
20522-0001
US

IV. Provider business mailing address

US DEPT OFSTATE M/MED/QI, SA-1
WASHINGTON DC
20522-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-663-2453
  • Fax: 202-663-3247
Mailing address:
  • Phone: 202-663-2453
  • Fax: 202-663-3247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10977
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: