Provider Demographics
NPI:1184653313
Name:CHANDRA, DINESH NARASIMHAIAH (MD)
Entity Type:Individual
Prefix:DR
First Name:DINESH
Middle Name:NARASIMHAIAH
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 1:2817 REILLY ST
Mailing Address - Street 2:WOMACK ARMY MEDICAL CENTER
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7324
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:1218 WALTER REED RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4440
Practice Address - Country:US
Practice Address - Phone:910-323-1671
Practice Address - Fax:910-323-9656
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401391207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC22072OtherBLUE CROSS/BLUE SHIELD OF NC
NC390005016OtherMEDICARE RAILROAD
NC8922072Medicaid
NC22072OtherBLUE CROSS/BLUE SHIELD OF NC
NC2208507AMedicare PIN