Provider Demographics
NPI:1902913718
Name:CHINTHALA, PRASANNA (MD)
Entity Type:Individual
Prefix:
First Name:PRASANNA
Middle Name:
Last Name:CHINTHALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3557 CORSHAM CIR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8211
Mailing Address - Country:US
Mailing Address - Phone:317-281-6586
Mailing Address - Fax:800-243-8260
Practice Address - Street 1:3557 CORSHAM CIR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8211
Practice Address - Country:US
Practice Address - Phone:317-281-6586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010856762084P0800X
IN01063241A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20880700AMedicaid
IN255880AMedicare PIN