Provider Demographics
NPI:1831509413
Name:PANDE, CHANDANA
Entity type:Individual
Prefix:
First Name:CHANDANA
Middle Name:
Last Name:PANDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MOUTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059
Mailing Address - Country:US
Mailing Address - Phone:908-769-0100
Mailing Address - Fax:908-769-2512
Practice Address - Street 1:34 MOUTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059
Practice Address - Country:US
Practice Address - Phone:908-769-0100
Practice Address - Fax:908-769-2512
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10169100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine