Provider Demographics
NPI:1356324206
Name:KOHLI, CHANDER M (MD)
Entity Type:Individual
Prefix:
First Name:CHANDER
Middle Name:M
Last Name:KOHLI
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 1:540 PARMALEE AVE STE 310
Mailing Address - Street 2:
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:
Practice Address - Street 1:540 PARMALEE AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1716
Practice Address - Country:US
Practice Address - Phone:330-747-1420
Practice Address - Fax:330-747-8979
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35034176K207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0249485Medicaid
OHA74064Medicare UPIN
OH0249485Medicaid