Provider Demographics
NPI:1609825777
Name:CHANDANI, ALI KASSAMALI (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:KASSAMALI
Last Name:CHANDANI
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 3120
Mailing Address - Street 2:STE 300
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33918-3120
Mailing Address - Country:US
Mailing Address - Phone:703-766-9737
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:3600 JOSEPH SIEWICK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1709
Practice Address - Country:US
Practice Address - Phone:703-391-3129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62061207L00000X
VA0101240896207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010359520Medicaid
VAK142-0001OtherCAREFIRST
VA484645OtherNCPPO
VA010360081Medicaid
VA139230OtherANTHEM
VA010359627Medicaid
VA010357349Medicaid
MD406953600Medicaid
MDKR79J754Medicare PIN
VA011541F81Medicare PIN
VA139230OtherANTHEM
VA484645OtherNCPPO