MEDICARE: SUSANNA CHANDLER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	U3182	TX

General Provider Information

NPI Number	:	1356970438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNA CHANDLER DO

Provider Business Mailing Address
First Line	:	9445 N BEACH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-9059
Country	:	US
Telephone Number	:	817-741-5437
Fax Number	:

Provider Business Practice Location Address
First Line	:	9445 N BEACH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-9059
Country	:	US
Telephone Number	:	817-741-5437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	06/08/2023

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Directions to “ SUSANNA CHANDLER DO” Practice Location

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