Provider Demographics
NPI:1780636027
Name:CHANDRAN, SUMITA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMITA
Middle Name:
Last Name:CHANDRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SUMITA
Other - Middle Name:
Other - Last Name:GANESAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3065
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:866-264-8519
Practice Address - Street 1:1600 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3065
Practice Address - Country:US
Practice Address - Phone:863-680-7000
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88758207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274741300Medicaid
FLU1400ZMedicare ID - Type UnspecifiedMEDICARE NUMBER
FL274741300Medicaid