Provider Demographics
NPI:1972780146
Name:CHAHAL, ANUPAM (MD)
Entity type:Individual
Prefix:
First Name:ANUPAM
Middle Name:
Last Name:CHAHAL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 EUCALYPTUS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-4317
Mailing Address - Country:US
Mailing Address - Phone:209-284-4561
Mailing Address - Fax:209-284-4562
Practice Address - Street 1:1079 EUCALYPTUS ST
Practice Address - Street 2:SUITE A
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-4317
Practice Address - Country:US
Practice Address - Phone:209-284-4561
Practice Address - Fax:209-284-4562
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP22025207R00000X
CAA121284207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA195372Medicare UPIN