Provider Demographics
NPI:1659463578
Name:CHANDLER, JAMES RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RUSSELL
Last Name:CHANDLER
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 1:1350 CROSSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9025
Mailing Address - Country:US
Mailing Address - Phone:802-229-4411
Mailing Address - Fax:802-371-4852
Practice Address - Street 1:1 FISHER ROAD
Practice Address - Street 2:CENTRAL VERMONT HOSPITAL
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-371-4315
Practice Address - Fax:802-371-5352
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT04200051772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004752Medicaid
VT00004752OtherBS
VTD78576Medicare UPIN
VTVT4752Medicare ID - Type Unspecified