Individual
DR. CHANCHAMMA THANNIKKARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
212 SMITH CHURCH RD, ROANOKE RAPIDS, NC 27870-4914
(252) 537-1717
(252) 537-1366
Mailing address
2234 COLONIAL BLVD, ATTN: PAYER CONTRACTING & RELATIONS, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
32057
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881654085
—
NC
05
—
1881654085
—
VA
01
—
3722179
CIGNA
NC
01
—
5760043
AETNA
NC
05
—
8982452
—
NC
01
—
P01269393
RAILROAD MCR
NC
Enumeration date
03/23/2006
Last updated
03/21/2014
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