Provider Demographics
NPI:1639489578
Name:RAMA E CHANDRAN MD INC
Entity Type:Organization
Organization Name:RAMA E CHANDRAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/SECRETARY OF THE ORG
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARASA
Authorized Official - Middle Name:V
Authorized Official - Last Name:CHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-644-1151
Mailing Address - Street 1:P.O. BOX 308
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250
Mailing Address - Country:US
Mailing Address - Phone:310-644-1151
Mailing Address - Fax:310-644-3115
Practice Address - Street 1:4477 WEST 118TH STREET
Practice Address - Street 2:SUITE 402
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250
Practice Address - Country:US
Practice Address - Phone:310-644-1151
Practice Address - Fax:310-644-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA324010207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A324010Medicaid
A324010Medicare PIN
D71910Medicare UPIN