Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD26862 | AL |
N | 2080A0000X | Adolescent Medicine | 26862 | AL |
NPI | 1003890849 |
---|---|
Provider Name | Dr. Ritu Chandra |
First Address | Phenix City, AL 36867-2993 |
Second Address | Phenix City, AL 36867-2993 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 25/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009940757 | (05) | AL |