Provider Demographics
NPI: | 1508846676 |
---|---|
Name: | CHANDOS, BRANDON J (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | BRANDON |
Middle Name: | J |
Last Name: | CHANDOS |
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: | 495 COOPER RD STE 212 |
Mailing Address - Street 2: | |
Mailing Address - City: | WESTERVILLE |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43081-8735 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 614-627-1400 |
Mailing Address - Fax: | 614-882-6097 |
Practice Address - Street 1: | 495 COOPER RD STE 212 |
Practice Address - Street 2: | |
Practice Address - City: | WESTERVILLE |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43081-8735 |
Practice Address - Country: | US |
Practice Address - Phone: | 614-627-1400 |
Practice Address - Fax: | 614-882-6097 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-01-17 |
Last Update Date: | 2022-03-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 35121477 | 2084S0012X, 2084N0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No | 2084S0012X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 0086499 | Medicaid | |
G28418 | Medicare UPIN | ||
OH | 0086499 | Medicaid |