Provider Demographics
NPI:1265100150
Name:CHANDRA, AJAY VENKAT
Entity type:Individual
Prefix:MR
First Name:AJAY
Middle Name:VENKAT
Last Name:CHANDRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4261 BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5015
Mailing Address - Country:US
Mailing Address - Phone:614-937-1652
Mailing Address - Fax:
Practice Address - Street 1:347 MIDWAY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2496
Practice Address - Country:US
Practice Address - Phone:440-324-5555
Practice Address - Fax:440-324-5512
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator