Basic Information
Provider Information
NPI: 1275581647
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHADDHA
FirstName: BINA
MiddleName: LILLY
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11995 SINGLETREE LN STE 500
Address2:  
City: EDEN PRAIRIE
State: MN
PostalCode: 553445349
CountryCode: US
TelephoneNumber: 9525951301
FaxNumber: 6122944903
Practice Location
Address1: 7 EVARTS LN
Address2:  
City: MADISON
State: CT
PostalCode: 064432564
CountryCode: US
TelephoneNumber: 9525951100
FaxNumber: 6122944903
Other Information
ProviderEnumerationDate: 05/05/2006
LastUpdateDate: 01/07/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X039130CTY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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