Provider Demographics
NPI:1992927636
Name:CHAKRABORTI, CHAMPA (MD)
Entity type:Individual
Prefix:DR
First Name:CHAMPA
Middle Name:
Last Name:CHAKRABORTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:C
Other - Middle Name:
Other - Last Name:CHAKRABORTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:115 ENGLISH TURN DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3319
Mailing Address - Country:US
Mailing Address - Phone:504-392-8436
Mailing Address - Fax:
Practice Address - Street 1:5001 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-2922
Practice Address - Country:US
Practice Address - Phone:504-349-8755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA160542084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine