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General NPI Number Information
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NPI Number | 1912993585
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Entity Type | Individual
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Provider Name | PADUBIDRI S CHANDRASHEKAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 107 MEDICAL PLAZA LN
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City | WHITESBURG
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State | KY
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Zip | 41858-7428
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Country | US
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Telephone | 606-633-7355
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Fax | 606-633-6325
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Provider Business Mailing Address
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Address Line | PO BOX 432
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City | PIKEVILLE
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State | KY
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Zip | 41502-0432
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Country | US
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Telephone | 606-633-7355
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Fax | 606-633-6325
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 29202
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License Number State | KY
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