Provider Demographics
NPI:1093888604
Name:CHANDRAN, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:CHANDRAN
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:PO BOX 35310
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87176-5310
Mailing Address - Country:US
Mailing Address - Phone:505-247-1744
Mailing Address - Fax:505-247-0797
Practice Address - Street 1:717 ENCINO PL NE STE 19
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2653
Practice Address - Country:US
Practice Address - Phone:505-247-1744
Practice Address - Fax:505-247-0797
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM76-18174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM05199Medicaid
NM05199Medicaid
2123707Medicare ID - Type Unspecified