Healthcare Provider Details

I. General information

NPI: 1619185097
Provider Name (Legal Business Name): DEEPA CHANDRASEKARAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 BEECH ST SUITE 502
HOLYOKE MA
01040-2223
US

IV. Provider business mailing address

575 BEECH ST
HOLYOKE MA
01040-2223
US

V. Phone/Fax

Practice location:
  • Phone: 413-534-2682
  • Fax:
Mailing address:
  • Phone: 413-534-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number232868
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: