MEDICARE: V CHOKKAVELU MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144325697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	V CHOKKAVELU MD INC

Provider Business Mailing Address
First Line	:	66761 ANNA DR
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-9241
Country	:	US
Telephone Number	:	740-433-4523
Fax Number	:	740-433-4523

Provider Business Practice Location Address
First Line	:	66761 ANNA DR
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-9241
Country	:	US
Telephone Number	:	740-433-4523
Fax Number	:	740-433-4523

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	VASANTHA CHOKKAVELU
Credential	:
Telephone Number	:	740-433-4523

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	04/09/2014

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