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General NPI Number Information
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NPI Number | 1457508079
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Entity Type | Individual
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Provider Name | CHAITRA CHANNAPPA MBBS
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Gender | Female
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 31 HOME DEPOT DR STE 283
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City | PLYMOUTH
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State | MA
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Zip | 02360-2669
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Country | US
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Telephone | 774-343-2432
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Fax |
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Provider Business Mailing Address
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Address Line | 31 HOME DEPOT DR STE 283
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City | PLYMOUTH
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State | MA
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Zip | 02360-2669
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Country | US
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Telephone | 774-343-2432
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2013-00450
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R-8277
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 271152
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License Number State | MA
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