Healthcare Provider Details

I. General information

NPI: 1831145200
Provider Name (Legal Business Name): JOSEPH J CHANDA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 SILVER PALM AVE
MELBOURNE FL
32901-3143
US

IV. Provider business mailing address

207 SILVER PALM AVE
MELBOURNE FL
32901-3143
US

V. Phone/Fax

Practice location:
  • Phone: 321-724-4010
  • Fax: 321-722-0442
Mailing address:
  • Phone: 321-724-4010
  • Fax: 321-722-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME32634
License Number StateFL

VIII. Authorized Official

Name: JOSEPH JOHN CHANDA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 321-724-4010