Provider Demographics
NPI:1508896457
Name:CHANDAN, KOMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:KOMAL
Middle Name:
Last Name:CHANDAN
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 1:4600 MILITARY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-1338
Mailing Address - Country:US
Mailing Address - Phone:716-298-4050
Mailing Address - Fax:
Practice Address - Street 1:4600 MILITARY RD
Practice Address - Street 2:SUITE A
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-1338
Practice Address - Country:US
Practice Address - Phone:716-298-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189392207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01371553Medicaid
CC8617Medicare PIN
E61437Medicare UPIN