Healthcare Provider Details

I. General information

NPI: 1679598486
Provider Name (Legal Business Name): DHARMENDER CHANDOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DHARMENDER CHANDHOK M.D.

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON STREET , TUFT MEDICAL CENTER, #298
BOSTON MA
02111
US

IV. Provider business mailing address

77 LEVBERT ROAD
NEWTON MA
02459
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-6044
  • Fax: 617-636-8384
Mailing address:
  • Phone: 781-665-3408
  • Fax: 781-665-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number202913
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: