Provider Demographics
NPI:1396709663
Name:CHAKRAVARTY, ELIZA FARMER (MD)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:FARMER
Last Name:CHAKRAVARTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:ANNE
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 268900
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8900
Mailing Address - Country:US
Mailing Address - Phone:405-271-6242
Mailing Address - Fax:405-271-2887
Practice Address - Street 1:820 NE 15TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4602
Practice Address - Country:US
Practice Address - Phone:405-271-6242
Practice Address - Fax:405-271-2887
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66676207R00000X, 207RR0500X
OK28540207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A666760Medicaid
CAH28316Medicare UPIN