Healthcare Provider Details

I. General information

NPI: 1992927636
Provider Name (Legal Business Name): CHAMPA CHAKRABORTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: C CHAKRABORTI MD

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 WESTBANK EXPY
MARRERO LA
70072-2922
US

IV. Provider business mailing address

115 ENGLISH TURN DR
NEW ORLEANS LA
70131-3319
US

V. Phone/Fax

Practice location:
  • Phone: 504-349-8755
  • Fax:
Mailing address:
  • Phone: 504-392-8436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number16054
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: