Provider Demographics
NPI:1366424541
Name:CHAKRAPANI, RAJA MOHAN (MD)
Entity type:Individual
Prefix:
First Name:RAJA
Middle Name:MOHAN
Last Name:CHAKRAPANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 PENN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TURTLE CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:15145-2085
Mailing Address - Country:US
Mailing Address - Phone:412-823-7390
Mailing Address - Fax:412-823-0611
Practice Address - Street 1:501 PENN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TURTLE CREEK
Practice Address - State:PA
Practice Address - Zip Code:15145-2085
Practice Address - Country:US
Practice Address - Phone:412-823-7390
Practice Address - Fax:412-823-0611
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055380L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001551164Medicaid
PA001551164Medicaid
G17797Medicare UPIN