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Individual

DR. SUPRIYA CHAKRAVARTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4235 SECOR RD, TOLEDO, OH 43623-4231
(419) 865-3939
Mailing address
4235 SECOR RD, TOLEDO, OH 43623-4231
(419) 865-3939

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
35040780
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
060070243
RAILROAD MEDICARE
01
P00181418
OHIO RAILROAD MEDICARE
OH
Enumeration date
07/07/2005
Last updated
01/25/2010
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