Provider Demographics
NPI:1376925164
Name:GEORGE CHANDRAN MD
Entity Type:Organization
Organization Name:GEORGE CHANDRAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOBATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-884-1214
Mailing Address - Street 1:PO BOX 35310
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87176-5310
Mailing Address - Country:US
Mailing Address - Phone:505-247-1744
Mailing Address - Fax:505-247-0797
Practice Address - Street 1:717 ENCINO PL NE
Practice Address - Street 2:SUITE 19
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2611
Practice Address - Country:US
Practice Address - Phone:505-247-1744
Practice Address - Fax:505-247-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM76-18207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1093888604Medicare PIN