Healthcare Provider Details

I. General information

NPI: 1639143852
Provider Name (Legal Business Name): SUSHELA S CHAIDARUN M.D., PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSHELA SONGTANIN

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DHMC ENDOCRINOLOGY SECTION, DEPT OF MEDICINE
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DHMC ENDOCRINOLOGY SECTION, DEPT OF MEDICINE
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-8630
  • Fax: 603-650-2240
Mailing address:
  • Phone: 603-650-8630
  • Fax: 603-650-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number14189
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: