Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 022984 | GA |
Y | 2081P2900X | Pain Medicine | 50829 | KY |
NPI | 1265445662 |
---|---|
Provider Name | Sushma Chandan |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 17/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300010647 | (05) | IN |
7100550970 | (05) | KY |