Provider Demographics
NPI:1649265828
Name:CHANDLER, JAMES D (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:CHANDLER
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 1:1234 E. DUPONT RD.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:AVILLA
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-897-3556
Mailing Address - Fax:260-458-5664
Practice Address - Street 1:125 BAUM STREET
Practice Address - Street 2:
Practice Address - City:AVILLA
Practice Address - State:IN
Practice Address - Zip Code:46710-0170
Practice Address - Country:US
Practice Address - Phone:260-897-3556
Practice Address - Fax:260-897-3650
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01022980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000559371OtherANTHEM
IN000000570562OtherANTHEM
IN100190780AMedicaid
INP00664344OtherMEDICARE RAILROAD
IN000000559371OtherANTHEM
IN580820Medicare PIN
IN069860RRRRMedicare PIN
INP00664344OtherMEDICARE RAILROAD