Provider Demographics
NPI:1144268608
Name:PEMMASANI, CHANDRA SEKHAR (MD)
Entity type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:SEKHAR
Last Name:PEMMASANI
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 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-5524
Mailing Address - Fax:410-601-8946
Practice Address - Street 1:2435 W BELVEDERE AVE
Practice Address - Street 2:SUITE 22
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5224
Practice Address - Country:US
Practice Address - Phone:410-601-6840
Practice Address - Fax:410-601-5789
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063121207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00267176OtherR/R MEDICARE PROVIDER #
MDC31152OtherR/R MEDICARE GROUP #
MD409198000Medicaid
MD409198000Medicaid
MDS589M949Medicare PIN
MDI46064Medicare UPIN
MD131976ZD2XMedicare PIN