Provider Demographics
NPI:1558358317
Name:NANDRA, CHARN S (MD)
Entity Type:Individual
Prefix:
First Name:CHARN
Middle Name:S
Last Name:NANDRA
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 1:380 SUMMIT AVENUE
Mailing Address - Street 2:MSO PHYSICIAN BILLING
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2667
Mailing Address - Country:US
Mailing Address - Phone:740-283-7597
Mailing Address - Fax:740-283-7807
Practice Address - Street 1:401 MARKET ST STE 902
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2867
Practice Address - Country:US
Practice Address - Phone:740-284-5522
Practice Address - Fax:740-284-5523
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18745207RC0000X
OH35.064092207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0086273001Medicaid
OH0150714Medicaid
OH0150714Medicaid
OHD26161Medicare UPIN
WV4109469Medicare PIN
P00100655Medicare PIN