Healthcare Provider Details

I. General information

NPI: 1053319905
Provider Name (Legal Business Name): CHANDLER PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 CHANDLER ST.
WORCESTER MA
01602
US

IV. Provider business mailing address

421 CHANDLER ST.
WORCESTER MA
01602
US

V. Phone/Fax

Practice location:
  • Phone: 508-752-4511
  • Fax: 508-797-4729
Mailing address:
  • Phone: 508-752-4511
  • Fax: 508-797-4729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: DR. LYNDA MARIE YOUNG
Title or Position: PHYSICIAN
Credential: MD
Phone: 508-752-4511