Basic Information
| Provider Information | |||||||||
| NPI: | 1629141817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHHABRA | ||||||||
| FirstName: | SHALINI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 PARK ST | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421011759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707815111 | ||||||||
| FaxNumber: | 2705262651 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 W ROBERTS ST | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422617942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705263841 | ||||||||
| FaxNumber: | 2705262651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 09/01/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 200500173 | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RG0300X | 44121 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2005-00173 | 01 | NC | LICENSE | OTHER | 7100163090 | 05 | KY | MEDICAID |