Provider Demographics
NPI:1386682052
Name:CHANDER, PUSHPA (MD)
Entity Type:Individual
Prefix:DR
First Name:PUSHPA
Middle Name:
Last Name:CHANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1552 UNION RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5523
Mailing Address - Country:US
Mailing Address - Phone:704-852-9210
Mailing Address - Fax:704-852-9211
Practice Address - Street 1:1552 UNION RD
Practice Address - Street 2:SUITE C
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5523
Practice Address - Country:US
Practice Address - Phone:704-852-9210
Practice Address - Fax:704-852-9211
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC94-01390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8922064Medicaid