Provider Demographics
NPI:1689023137
Name:NANDWANI, SOHEIL CHANDRU (MD)
Entity Type:Individual
Prefix:
First Name:SOHEIL
Middle Name:CHANDRU
Last Name:NANDWANI
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 1:721 BROAD ST APT 501
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-1824
Mailing Address - Country:US
Mailing Address - Phone:865-621-2223
Mailing Address - Fax:
Practice Address - Street 1:7402 LEE HWY
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1405
Practice Address - Country:US
Practice Address - Phone:423-242-9750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000062004207P00000X
IN11018744A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine