Healthcare Provider Details

I. General information

NPI: 1831161520
Provider Name (Legal Business Name): SUPRAJA CHIRRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 CHRISTIANA MEDICAL CTR
NEWARK DE
19702-1655
US

IV. Provider business mailing address

1602 NEWPORT GAP PIKE
WILMINGTON DE
19808-6208
US

V. Phone/Fax

Practice location:
  • Phone: 302-454-8880
  • Fax: 302-454-1095
Mailing address:
  • Phone: 302-633-5840
  • Fax: 302-633-5844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0005586
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: