Provider Demographics
NPI:1013004944
Name:CHANDLER DERMATOLOGY LTD
Entity Type:Organization
Organization Name:CHANDLER DERMATOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-985-1093
Mailing Address - Street 1:312 N ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4354
Mailing Address - Country:US
Mailing Address - Phone:480-985-1093
Mailing Address - Fax:
Practice Address - Street 1:312 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4354
Practice Address - Country:US
Practice Address - Phone:480-985-1093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ0000BGMTWMedicare PIN