Provider Demographics
NPI:1609084151
Name:CHANDARANA, KHUSHBU ANIRUDHDHA (MD)
Entity Type:Individual
Prefix:DR
First Name:KHUSHBU
Middle Name:ANIRUDHDHA
Last Name:CHANDARANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KHUSHBU
Other - Middle Name:
Other - Last Name:CHANDARANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:550 NEW WAVERLY PL
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7412
Mailing Address - Country:US
Mailing Address - Phone:919-642-3738
Mailing Address - Fax:919-585-1554
Practice Address - Street 1:550 NEW WAVERLY PL
Practice Address - Street 2:SUITE 120
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7412
Practice Address - Country:US
Practice Address - Phone:919-642-3738
Practice Address - Fax:919-585-1554
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-00723207RE0101X
NJ25MA07958500207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1609084151Medicaid
NCNCO558E871Medicare PIN