MEDICARE: DR. KISHANLAL CHAKRABARTI MD

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	2084P0800X	Psychiatry Physician	42216	MA

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

General Provider Information

NPI Number	:	1659365856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KISHANLAL CHAKRABARTI MD

Provider Business Mailing Address
First Line	:	14 AVON RD
Second Line	:
City	:	WATERTOWN
State	:	MA
Zip	:	02472-4932
Country	:	US
Telephone Number	:	617-539-1318
Fax Number	:	866-274-0418

Provider Business Practice Location Address
First Line	:	120 BANKS ST
Second Line	:
City	:	WINTHROP
State	:	MA
Zip	:	02152-1931
Country	:	US
Telephone Number	:	617-539-1318
Fax Number	:	866-274-0418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	07/23/2007

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