Provider Demographics
NPI:1669425591
Name:MENDIS, CHANDIRA K (MD)
Entity type:Individual
Prefix:DR
First Name:CHANDIRA
Middle Name:K
Last Name:MENDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 W TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1559
Mailing Address - Country:US
Mailing Address - Phone:484-416-0880
Mailing Address - Fax:484-416-0660
Practice Address - Street 1:4 W TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1559
Practice Address - Country:US
Practice Address - Phone:484-416-0880
Practice Address - Fax:484-416-0660
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072006L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001817015Medicaid
PA232359401OtherMAIN LINE HEALTHCARE
H24361Medicare UPIN
PA232359401OtherMAIN LINE HEALTHCARE