Provider Demographics
NPI:1992786594
Name:CHANDRAHASA, THONGADI R (MD)
Entity type:Individual
Prefix:
First Name:THONGADI
Middle Name:R
Last Name:CHANDRAHASA
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:PO BOX 496498
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-6498
Mailing Address - Country:US
Mailing Address - Phone:941-743-2277
Mailing Address - Fax:941-743-2275
Practice Address - Street 1:3400 TAMIAMI TRL
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8102
Practice Address - Country:US
Practice Address - Phone:941-743-2277
Practice Address - Fax:941-743-2275
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32635207RC0200X, 207RP1001X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD84979Medicare UPIN
FL08082Medicare ID - Type Unspecified