Individual
DR. CHAITRA CHANNAPPA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MBBS
Contact information
Practice address
31 HOME DEPOT DR STE 283, PLYMOUTH, MA 02360-2669
(774) 343-2432
Mailing address
31 HOME DEPOT DR STE 283, PLYMOUTH, MA 02360-2669
(774) 343-2432
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2013-00450
NC
207Q00000X
Family Medicine Physician
R-8277
IA
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
271152
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2013-00450
LICENSE
NC
01
—
271152
MA MEDICAL LICENSE BOARD
MA
Enumeration date
08/26/2008
Last updated
07/21/2022
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