Provider Demographics
NPI:1942753694
Name:CHANDER DEVARAJ MD LLC
Entity Type:Organization
Organization Name:CHANDER DEVARAJ MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-550-8348
Mailing Address - Street 1:920 FOXON RD
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-1868
Mailing Address - Country:US
Mailing Address - Phone:203-468-9190
Mailing Address - Fax:203-468-6952
Practice Address - Street 1:920 FOXON RD
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-1868
Practice Address - Country:US
Practice Address - Phone:203-468-9190
Practice Address - Fax:203-468-6952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty