Provider Demographics
NPI:1144216573
Name:CHANDRA, USHA (MD)
Entity Type:Individual
Prefix:
First Name:USHA
Middle Name:
Last Name:CHANDRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:USHA
Other - Middle Name:
Other - Last Name:BHARDWAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502
Mailing Address - Country:US
Mailing Address - Phone:580-357-9984
Mailing Address - Fax:580-357-3277
Practice Address - Street 1:4411 W GORE BLVD
Practice Address - Street 2:SUITE A2
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:580-355-0575
Practice Address - Fax:580-248-1725
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5100141OtherAETNA
080081662OtherRAILROAD MEDICARE
OK100040430BMedicaid
OK100040430FMedicaid
OK5100141OtherAETNA
080081662OtherRAILROAD MEDICARE