Basic Information
| Provider Information | |||||||||
| NPI: | 1649488230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAI | ||||||||
| FirstName: | CHETAN | ||||||||
| MiddleName: | BALAKRISHNA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8411 BROADMORE LN | ||||||||
| Address2: | |||||||||
| City: | SPOTSYLVANIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 225533645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403717600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1031 CARE WAY | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224018425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403717600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 03/16/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 0102202540 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.