Provider Demographics
NPI:1447661723
Name:CHHATRALA, HARDIK (MD)
Entity type:Individual
Prefix:
First Name:HARDIK
Middle Name:
Last Name:CHHATRALA
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 1:7015 A C SKINNER PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6932
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-363-2606
Practice Address - Street 1:7015 A C SKINNER PKWY BLDG 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6932
Practice Address - Country:US
Practice Address - Phone:904-516-3737
Practice Address - Fax:904-516-3738
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME147990207RH0003X, 207RH0003X
FLTRN26196207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110770300Medicaid
NJ25MA10111500OtherNJ MEDICAL LICENSE
FLP98G3OtherFL BLUE
FLNZ922OtherMEDICARE