Provider Demographics
NPI:1831145200
Name:JOSEPH J CHANDA MD PA
Entity Type:Organization
Organization Name:JOSEPH J CHANDA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CHANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-724-4010
Mailing Address - Street 1:207 SILVER PALM AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3143
Mailing Address - Country:US
Mailing Address - Phone:321-724-4010
Mailing Address - Fax:321-722-0442
Practice Address - Street 1:207 SILVER PALM AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3143
Practice Address - Country:US
Practice Address - Phone:321-724-4010
Practice Address - Fax:321-722-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32634207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037366400Medicaid
406073261OtherRAILROAD MEDICARE
FL05392OtherBCBS OF FLORIDA
=========OtherHUMANA
FL037366400Medicaid
=========OtherUNITED HEALTH CARE
=========OtherMULTIPLAN
FL05392OtherBCBS OF FLORIDA
=========OtherCCN
=========OtherFIRST HEALTH
=========OtherUNITED HEALTH CARE
=========OtherHUMANA