Provider Demographics
NPI:1073177184
Name:LAUREL CHANDLER MD PLLC
Entity Type:Organization
Organization Name:LAUREL CHANDLER MD PLLC
Other - Org Name:CHANDLER PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-460-0211
Mailing Address - Street 1:41 PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1271
Mailing Address - Country:US
Mailing Address - Phone:978-460-0211
Mailing Address - Fax:
Practice Address - Street 1:195 DANBURY RD STE 203
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4075
Practice Address - Country:US
Practice Address - Phone:203-423-3132
Practice Address - Fax:203-423-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063778082OtherINDIVIDUAL NPI