Chanchamma Thannikkary, M.D.

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

32057 Issued in NC

Practice address

212 Smith Church Rd
Roanoke Rapids, NC 27870-4914

Phone

(252) 537-1717

Fax

(252) 537-1366

NPI assigned

Mar 23, 2006

Last updated

Mar 21, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Roanoke Valley Cancer Center Inc.

  • Radiation Oncology Physician
  • Roanoke Rapids, NC
  • NPI 1134165640
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395360000000",
    "number": "1881654085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2234 COLONIAL BLVD",
            "address_2": "ATTN: PAYER CONTRACTING & RELATIONS",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071412",
            "telephone_number": "239-931-7342",
            "fax_number": "239-931-7385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 SMITH CHURCH RD",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278704914",
            "telephone_number": "252-537-1717",
            "fax_number": "252-537-1366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THANNIKKARY",
        "first_name": "CHANCHAMMA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-23",
        "last_updated": "2014-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NC",
            "license": "32057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881654085",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881654085",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5760043",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "3722179",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8982452",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCR",
            "identifier": "P01269393",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Larry Swinton, LCAS-A
• Robert E Sykes Jr., LMFT
• Karen Holloway Tanner, PTA
• Ericka Taylor-Daniel, MSN,APRN,PMHNP-BC,
• Adrianne Teague, LPC, LCASA
• The Mental Health Association in North Carolina Inc (Halifax SE)
• The Mental Health Association in North Carolina, Inc (Halifax CST)
• The Mental Health Association in North Carolina, Inc (Halifax ACTT)
• The Mental Health Association in North Carolina, Inc (Halifax ACTT)
• The Mental Health Association in North Carolina, Inc (Halifax PSR)

• Radiation Oncology Physician in Roanoke Rapids, NC
• Providers in Roanoke Rapids, NC by specialty
• Radiation Oncology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.