Provider Demographics
NPI:1598786725
Name:CHAKRABARTY, AMIT (MD)
Entity type:Individual
Prefix:DR
First Name:AMIT
Middle Name:
Last Name:CHAKRABARTY
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 1:121 COVESHIRE PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3150
Mailing Address - Country:US
Mailing Address - Phone:352-398-4276
Mailing Address - Fax:352-291-0087
Practice Address - Street 1:3201 SW 34TH ST STE F
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7439
Practice Address - Country:US
Practice Address - Phone:352-398-4276
Practice Address - Fax:352-291-0087
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA70357208800000X
IN01058611A208800000X
FLME125251208800000X
MO2500020935208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009935341Medicaid
AL51532618OtherBCBS
FL123334100Medicaid
MO200018019Medicaid
AL000092909OtherMEDICARE