Provider Demographics
NPI:1891741179
Name:CHANDY, ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CHANDY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HOSPITAL PKWY
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6913
Mailing Address - Country:US
Mailing Address - Phone:817-848-2708
Mailing Address - Fax:817-848-4579
Practice Address - Street 1:1600 HOSPITAL PKWY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6913
Practice Address - Country:US
Practice Address - Phone:817-848-2708
Practice Address - Fax:817-848-4579
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1046208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176191803Medicaid
TX8F3315OtherBCBS
TX1761918-01Medicaid
TXP00315340OtherRAILROAD MEDICARE
TX176191802Medicaid
TX8M7954OtherBCBS
TX176191802Medicaid
TX8G2829Medicare PIN
TXI42755Medicare UPIN
TX1761918-01Medicaid