Provider Demographics
NPI:1669597241
Name:CHIDAMBARAN, PREETA (MD)
Entity type:Individual
Prefix:DR
First Name:PREETA
Middle Name:
Last Name:CHIDAMBARAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PREETA
Other - Middle Name:
Other - Last Name:NARAYANASWAMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:164 LONGWOOD AVE
Mailing Address - Street 2:ROOM 324
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:710 LAWRENCE EXPY
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5173
Practice Address - Country:US
Practice Address - Phone:408-851-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72473207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine