Healthcare Provider Details

I. General information

NPI: 1699267385
Provider Name (Legal Business Name): MANJU CHANDRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANJU GIRISH CHANDRAN MD

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE L304
LEXINGTON KY
40536-6712
US

IV. Provider business mailing address

740 S LIMESTONE STE L304
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-3900
  • Fax: 859-257-8138
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301114876
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60786
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: