MEDICARE: DR. KANISHKA CHAKRABORTY M.D

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	207R00000X	Internal Medicine Physician	47679	TN
2	207RX0202X	Medical Oncology Physician	47679	TN

General Provider Information

NPI Number	:	1992993760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KANISHKA CHAKRABORTY M.D

Provider Business Mailing Address
First Line	:	900 E HILL AVE STE 230
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37915-2565
Country	:	US
Telephone Number	:	865-862-0998
Fax Number	:	865-544-1861

Provider Business Practice Location Address
First Line	:	4 SHERIDAN SQ STE 102
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37660-7435
Country	:	US
Telephone Number	:	423-588-7140
Fax Number	:	423-588-7141

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

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	07/02/2024

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