Chatram Mahabal, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

12185 Issued in CT

Practice address

88 Norwich New London Tpke Ste 2
Uncasville, CT 06382-2518

Phone

(860) 477-7072

NPI assigned

Jul 21, 2023

Last updated

Aug 3, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Southeastern Connecticut Nephrology Associates PC

  • Nephrology Physician
  • Uncasville, CT
  • NPI 1619031796
  Medicare reassignment NPD
• Southeastern CT Nephrology Assoc.

  • Adult Health Nurse Practitioner
  • Uncasville, CT
  • NPI 1821426099
  NPD (past)

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

{
    "created_epoch": "1689897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691020800000",
    "number": "1972283208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88 NORWICH NEW LONDON TPKE STE 2",
            "city": "UNCASVILLE",
            "state": "CT",
            "postal_code": "063822518",
            "telephone_number": "860-477-7072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 NORWICH NEW LONDON TPKE STE 2",
            "city": "UNCASVILLE",
            "state": "CT",
            "postal_code": "063822518",
            "telephone_number": "860-477-7072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHABAL",
        "first_name": "CHATRAM",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-21",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "12185",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CT",
            "license": "12185",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Khristine S Lariviere, RPH
• Madeleine Sherwood Lefker, M.A., CCC SLP
• Ona Liu, DDS
• Jacqueline Luke, PHARMD
• Renee Lundfelt, OTR/L
• Kristin Marie Mahan
• Danielle Lee Mallory, APRN FNP-BC
• Melissa Maltese
• Natalie Marble
• Ashley Nicole Marek

• Family Nurse Practitioner in Uncasville, CT
• Providers in Uncasville, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.