Healthcare Provider Details

I. General information

NPI: 1023084167
Provider Name (Legal Business Name): NR CHANDRASEKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COLTS XING
CANTON MA
02021-1367
US

IV. Provider business mailing address

25 COLTS XING
CANTON MA
02021-1367
US

V. Phone/Fax

Practice location:
  • Phone: 617-285-9780
  • Fax:
Mailing address:
  • Phone: 617-285-9780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number150595
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: