Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DS027784L | PA |
NPI | 1003914078 |
---|---|
Provider Name | Charu S Chandra |
First Address | Zelienople, PA 16063 |
Second Address | Zelienople, PA 16063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 08/07/2007 |