Provider Demographics
NPI:1942281944
Name:DAS, DINES CHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:DINES
Middle Name:CHANDRA
Last Name:DAS
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 1:901 E OAK ST
Mailing Address - Street 2:STE A
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5837
Mailing Address - Country:US
Mailing Address - Phone:407-846-1044
Mailing Address - Fax:407-846-3523
Practice Address - Street 1:901 E OAK ST
Practice Address - Street 2:STE A
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5837
Practice Address - Country:US
Practice Address - Phone:407-846-1044
Practice Address - Fax:407-846-3523
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19806207RC0000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058581500Medicaid
D59786Medicare UPIN
FL058581500Medicaid