Provider Demographics
NPI:1477547602
Name:CHANDRA, SUMESH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMESH
Middle Name:
Last Name:CHANDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SUMESH
Other - Middle Name:
Other - Last Name:CHANDRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:13801 BRUCE B DOWNS BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3937
Mailing Address - Country:US
Mailing Address - Phone:813-977-5557
Mailing Address - Fax:813-972-9211
Practice Address - Street 1:13801 BRUCE B DOWNS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3937
Practice Address - Country:US
Practice Address - Phone:813-977-5557
Practice Address - Fax:813-972-9211
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034899207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30302OtherBCBS INDIVIDUAL
FLDB6684OtherRR MCARE GRUOUP
FL270620200Medicaid
FL039760100Medicaid
FL410111141OtherRR MCARE INDIVIDUAL
FL74830OtherBCBS GROUP