Basic Information
| Provider Information | |||||||||
| NPI: | 1457302143 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAKRABARTI | ||||||||
| FirstName: | INDRANIL | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174218 | ||||||||
| Practice Location | |||||||||
| Address1: | 176 S COLDBROOK AVE | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172012712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172677480 | ||||||||
| FaxNumber: | 7172677403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 10/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0805X | MD427514 | PA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | 2084P0800X | MD427514 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 50072044 | 01 | PA | CAPITAL BLUECROSS | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | BC9466500 | 01 | PA | DEA | OTHER | 1695953 | 01 | PA | AETNA HMO | OTHER | 25-1716306 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER | 9296081 | 01 | PA | AETNA NON-HMO | OTHER | MD427514 | 01 | PA | LICENSE | OTHER | 102058497 0002 0003 | 05 | PA | MEDICAID | 25-1716306 | 01 | PA | INTERGROUP | OTHER | 25-1716306 | 01 | PA | INFORMED | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | G920-0067/233CCU | 01 | PA | CAREFIRST | OTHER | 120420406 | 01 | PA | DEPT OF LABOR | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | 25-1716306 | 01 | PA | FIRST HEALTH | OTHER | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | CH1979148 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | P00432902 | 01 | PA | RAILROAD MEDICARE | OTHER |