Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0101X | MOHS-Micrographic Surgeon | ME32634 | FL |
N | 207NS0135X | Procedural Dermatology | 4301035259 | MI |
N | 207NS0135X | Procedural Dermatology | 6783 | SC |
Y | 207NS0135X | Procedural Dermatology | ME32634 | FL |
NPI | 1538115548 |
---|---|
Provider Name | Joseph John Chanda |
First Address | Melbourne, FL 32901-3143 |
Second Address | Melbourne, FL 32901-3143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 05/10/2020 |