Provider Demographics
NPI:1285637918
Name:CHANDER M. KOHLI M.D., INC.
Entity Type:Organization
Organization Name:CHANDER M. KOHLI M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDER
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-747-1420
Mailing Address - Street 1:540 PARMALEE AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1605
Mailing Address - Country:US
Mailing Address - Phone:330-747-1420
Mailing Address - Fax:330-747-1151
Practice Address - Street 1:540 PARMALEE AVE
Practice Address - Street 2:STE 310
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1605
Practice Address - Country:US
Practice Address - Phone:330-747-1420
Practice Address - Fax:330-747-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-4176 K174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0589359Medicaid
OH4934040001Medicare NSC
OHA74064Medicare UPIN
OH0589359Medicaid
PA023487Medicare PIN