Provider Demographics
NPI:1003890849
Name:CHANDRA, RITU (MD)
Entity Type:Individual
Prefix:DR
First Name:RITU
Middle Name:
Last Name:CHANDRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 S RAILROAD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-2993
Mailing Address - Country:US
Mailing Address - Phone:334-664-0463
Mailing Address - Fax:334-664-0466
Practice Address - Street 1:3700 S RAILROAD ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-2993
Practice Address - Country:US
Practice Address - Phone:334-664-0463
Practice Address - Fax:334-664-0466
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL268622080A0000X
ALMD26862208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009940757Medicaid