Provider Demographics
NPI:1063468312
Name:CHANDRA, PRASAD G (MD)
Entity Type:Individual
Prefix:
First Name:PRASAD
Middle Name:G
Last Name:CHANDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6045 BRIDGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-3049
Mailing Address - Country:US
Mailing Address - Phone:513-981-4105
Mailing Address - Fax:513-347-4620
Practice Address - Street 1:6045 BRIDGETOWN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-3049
Practice Address - Country:US
Practice Address - Phone:513-981-4105
Practice Address - Fax:513-347-4620
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0481787Medicaid
OHC02256Medicare UPIN
OH0481787Medicaid