Provider Demographics
NPI:1821043746
Name:CHANDRA, PRASANTA C (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:PRASANTA
Middle Name:C
Last Name:CHANDRA
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
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Other - Credentials:
Mailing Address - Street 1:468 HURFFVILLE CROSSKEYS RD
Mailing Address - Street 2:ATRIUM II SUITE IV
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2322
Mailing Address - Country:US
Mailing Address - Phone:856-582-2111
Mailing Address - Fax:856-582-9781
Practice Address - Street 1:468 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:ATRIUM II SUITE IV
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2322
Practice Address - Country:US
Practice Address - Phone:856-582-2111
Practice Address - Fax:856-582-9781
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04162100207VM0101X
NY1236121207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC05519Medicare UPIN