Provider Demographics
NPI:1730173386
Name:PARAKRAMA T CHANDRASOMA MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:PARAKRAMA T CHANDRASOMA MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARAKRAMA
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHANDRASOMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-409-4600
Mailing Address - Street 1:405 LINDA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1237
Mailing Address - Country:US
Mailing Address - Phone:626-304-1055
Mailing Address - Fax:323-441-8183
Practice Address - Street 1:405 LINDA VISTA AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-1237
Practice Address - Country:US
Practice Address - Phone:626-304-1055
Practice Address - Fax:323-441-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A342840Medicaid
CAW17840Medicare PIN