Provider Demographics
NPI:1275583585
Name:ABBOY, CHANDAR RAJA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDAR
Middle Name:RAJA
Last Name:ABBOY
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 1:151 HAROLD FLEMING COURT
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-4225
Mailing Address - Country:US
Mailing Address - Phone:864-573-6320
Mailing Address - Fax:
Practice Address - Street 1:151 HAROLD FLEMING COURT
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4225
Practice Address - Country:US
Practice Address - Phone:864-573-6320
Practice Address - Fax:864-573-6323
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31600207RC0200X, 207RP1001X
NC2011-01582207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3212Medicaid
SC316009Medicaid
NC5913244Medicaid
SCI29640Medicare UPIN
SCGP3212Medicaid
SC316009Medicaid
SCAA41567034Medicare PIN
SCAA41565019Medicare PIN