Provider Demographics
NPI:1265445662
Name:CHANDAN, SUSHMA (MD)
Entity Type:Individual
Prefix:
First Name:SUSHMA
Middle Name:
Last Name:CHANDAN
Suffix:
Gender:F
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 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-899-3623
Mailing Address - Fax:502-899-7970
Practice Address - Street 1:220 ABRAHAM FLEXNER WAY STE 1200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-584-3377
Practice Address - Fax:502-584-3480
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0229842081P2900X
KY508292081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300010647Medicaid
KY7100550970Medicaid