Provider Demographics
NPI:1750584389
Name:BANWAT, CHANDA (MD)
Entity type:Individual
Prefix:DR
First Name:CHANDA
Middle Name:
Last Name:BANWAT
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 1:1450 TREAT BLVD # 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2168
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:
Practice Address - Street 1:1450 TREAT BLVD
Practice Address - Street 2:SUITE 220A
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-2168
Practice Address - Country:US
Practice Address - Phone:925-296-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010019739207R00000X
CA116373207R00000X
CAA116373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01371574OtherRAILROAD MEDICARE
CAP01371574OtherRAILROAD MEDICARE