Provider Demographics
NPI:1598962391
Name:CHANDRAKANTAN, ARVIND (MD)
Entity Type:Individual
Prefix:
First Name:ARVIND
Middle Name:
Last Name:CHANDRAKANTAN
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:PO BOX 1559
Mailing Address - Street 2:STONY BROOK ANAESTHESIOLOGY
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-2975
Mailing Address - Fax:
Practice Address - Street 1:100 NICOLLS RD # HSC
Practice Address - Street 2:L4 RM 060
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8480
Practice Address - Country:US
Practice Address - Phone:631-444-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259484207L00000X
TN44772207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY259484OtherNY STATE LICENSE #
TN3041847Medicaid
TNME102028OtherSTATE LICENSE
TN3041847Medicaid