Provider Demographics
NPI:1093716870
Name:CHANDRA, ANURAG (MD)
Entity Type:Individual
Prefix:
First Name:ANURAG
Middle Name:
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 1:43 NEW SCOTLAND AVE # MC95
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3412
Mailing Address - Country:US
Mailing Address - Phone:518-262-3368
Mailing Address - Fax:518-262-3399
Practice Address - Street 1:43 NEW SCOTLAND AVE # MC95
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-3368
Practice Address - Fax:518-262-3399
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2317592085R0001X
NJ25MA083911002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0064963Medicaid
NY02547015Medicaid
NJ60046802OtherHORIZON NJ HEALTH
NJ0409316OtherGHI
NJ6986950OtherCIGNA
NJP00732364OtherRAILROAD MEDICARE
NY2359E1Medicare PIN
NJ60046802OtherHORIZON NJ HEALTH
NJ6986950OtherCIGNA