MEDICARE: DR. KOMAL CHANDAN M.D

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	207QA0505X	Adult Medicine Physician	189392	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508896457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KOMAL CHANDAN M.D

Provider Business Mailing Address
First Line	:	4600 MILITARY RD
Second Line	:	SUITE A
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14305-1338
Country	:	US
Telephone Number	:	716-298-4050
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 MILITARY RD
Second Line	:	SUITE A
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14305-1338
Country	:	US
Telephone Number	:	716-298-4050
Fax Number	:

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/12/2010

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