Provider Demographics
NPI:1588845200
Name:LAILA E. CHANDY, M.D., PROF. COPR
Entity Type:Organization
Organization Name:LAILA E. CHANDY, M.D., PROF. COPR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAILA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHANDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-589-4305
Mailing Address - Street 1:2767 OLIVE HWY
Mailing Address - Street 2:P O BOX 809
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6118
Mailing Address - Country:US
Mailing Address - Phone:530-589-4305
Mailing Address - Fax:530-589-3965
Practice Address - Street 1:2767 OLIVE HWY
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6118
Practice Address - Country:US
Practice Address - Phone:530-589-4305
Practice Address - Fax:530-589-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A416170207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAO5D1022410OtherCLIA
CA00A416170Medicaid
CAZZZ29536ZMedicare PIN
CA00A416170Medicaid