Provider Demographics
NPI:1366625881
Name:CHANDRAS CLINIC PC
Entity Type:Organization
Organization Name:CHANDRAS CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SATYANARAYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRAGIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-269-9915
Mailing Address - Street 1:PO BOX 4060
Mailing Address - Street 2:1249 FAIRVIEW AVENUE SE
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:503-269-9915
Mailing Address - Fax:503-907-9933
Practice Address - Street 1:1249 FAIRVIEW AVENUE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:503-269-9915
Practice Address - Fax:503-907-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD222142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1376693275OtherNPI NUMBER
OR1376693275OtherNPI NUMBER