Provider Demographics
NPI:1174817720
Name:CHANDRA, SUBHASH (MBBS)
Entity type:Individual
Prefix:
First Name:SUBHASH
Middle Name:
Last Name:CHANDRA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 S LINDSAY RD STE 115
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-4334
Mailing Address - Country:US
Mailing Address - Phone:602-249-8578
Mailing Address - Fax:602-613-3832
Practice Address - Street 1:3011 S LINDSAY RD STE 115
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-4334
Practice Address - Country:US
Practice Address - Phone:602-249-8578
Practice Address - Fax:602-613-3832
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ64301207RG0100X, 207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
07258775OtherECFMG