Provider Demographics
NPI:1326230145
Name:CHANDRASEKAR, DURAISWAMY (MD)
Entity Type:Individual
Prefix:
First Name:DURAISWAMY
Middle Name:
Last Name:CHANDRASEKAR
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 1:189 CRESTWOOD DR
Mailing Address - Street 2:#20
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-3253
Mailing Address - Country:US
Mailing Address - Phone:650-756-8586
Mailing Address - Fax:
Practice Address - Street 1:189 CRESTWOOD DR
Practice Address - Street 2:#20
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-3253
Practice Address - Country:US
Practice Address - Phone:650-756-8586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC043336208600000X, 208800000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208800000XAllopathic & Osteopathic PhysiciansUrology