Provider Demographics
NPI:1871555904
Name:CHAPA, SUKUMAR M (MD)
Entity type:Individual
Prefix:
First Name:SUKUMAR
Middle Name:M
Last Name:CHAPA
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 447
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0447
Mailing Address - Country:US
Mailing Address - Phone:814-849-5151
Mailing Address - Fax:814-849-9624
Practice Address - Street 1:240 ALLEGHENY BLVD
Practice Address - Street 2:STE A
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-2323
Practice Address - Country:US
Practice Address - Phone:814-849-5151
Practice Address - Fax:814-849-9624
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038943L174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008219620002Medicaid
PA0008219620002Medicaid
PA022179Medicare PIN