Provider Demographics
NPI:1497166730
Name:CHANDRA, GAURAV M (MD)
Entity Type:Individual
Prefix:
First Name:GAURAV
Middle Name:M
Last Name:CHANDRA
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:10 HERITAGE CT
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1109
Mailing Address - Country:US
Mailing Address - Phone:516-695-8274
Mailing Address - Fax:
Practice Address - Street 1:114 E 27TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8969
Practice Address - Country:US
Practice Address - Phone:855-295-4144
Practice Address - Fax:212-889-9058
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY294143207WX0107X, 207WX0108X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology