Provider Demographics
NPI:1871607796
Name:CHANDRAMOULI, B V (MD)
Entity type:Individual
Prefix:
First Name:B
Middle Name:V
Last Name:CHANDRAMOULI
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 1:1555 EAST ST
Mailing Address - Street 2:STE 100
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-244-4477
Mailing Address - Fax:530-244-1407
Practice Address - Street 1:1555 EAST ST
Practice Address - Street 2:STE 100
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-244-4477
Practice Address - Fax:530-244-1407
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A521990207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A521990Medicaid
CA060070712OtherRAILROAD
CA060070712OtherRAILROAD
CA00A521990Medicaid