Provider Demographics
NPI:1407018229
Name:CHANDLER & THAKUR MEDICAL GROUP
Entity Type:Organization
Organization Name:CHANDLER & THAKUR MEDICAL GROUP
Other - Org Name:THE CHANDLER & THAKUR MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRONELL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-352-3585
Mailing Address - Street 1:29 GLENDALE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2513
Mailing Address - Country:US
Mailing Address - Phone:610-352-3585
Mailing Address - Fax:610-352-2979
Practice Address - Street 1:29 GLENDALE RD
Practice Address - Street 2:SUITE A
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2513
Practice Address - Country:US
Practice Address - Phone:610-352-3585
Practice Address - Fax:610-352-2979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0481892174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG35867Medicare UPIN