Individual
DAN CHAKSUPA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3521 HAWORTH DR, RALEIGH, NC 27609-7244
(919) 782-1669
(919) 782-4756
Mailing address
PO BOX 18563, RALEIGH, NC 27619-8563
(919) 782-1806
(919) 782-1669
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2005-01602
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5902990
—
NC
Enumeration date
08/18/2006
Last updated
03/08/2011
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