MEDICARE: ANANDA B. CHELLAPPAN 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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1730448358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANANDA B. CHELLAPPAN INC

Provider Business Mailing Address
First Line	:	4906 CUTSHAW AVE
Second Line	:	SUITE 104
City	:	RICHMOND
State	:	VA
Zip	:	23230-3630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4906 CUTSHAW AVE
Second Line	:	SUITE 104
City	:	RICHMOND
State	:	VA
Zip	:	23230-3630
Country	:	US
Telephone Number	:	804-562-5302
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OFFICE MGR
Name	:	MRS. LORI G BURTON
Credential	:
Telephone Number	:	804-562-5302

Provider Enumeration Date	:	05/16/2012
Last Update Date	:	06/01/2012

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