Provider Demographics
NPI:1497890107
Name:CHANDLER, BRONELL ELBERT (MD)
Entity Type:Individual
Prefix:
First Name:BRONELL
Middle Name:ELBERT
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 GLENDALE RD
Mailing Address - Street 2:
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
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048189L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA018783Medicare ID - Type Unspecified