Provider Demographics
NPI:1720295702
Name:CHANDRASEKARAN, VISALAM (MD)
Entity Type:Individual
Prefix:DR
First Name:VISALAM
Middle Name:
Last Name:CHANDRASEKARAN
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 1:148 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3015
Mailing Address - Country:US
Mailing Address - Phone:516-484-3391
Mailing Address - Fax:
Practice Address - Street 1:THE NEW YORK BLOOD CENTER
Practice Address - Street 2:310, E 67 STREET
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-570-3142
Practice Address - Fax:212-570-3092
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY 135860207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine