Healthcare Provider Details

I. General information

NPI: 1912126244
Provider Name (Legal Business Name): KAILASH CHANDWANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FNU KAILASH M.D.

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 DAWN DR SUITE 3300
LUMBERTON NC
28360-8287
US

IV. Provider business mailing address

2002 N CEDAR ST STE B
LUMBERTON NC
28358-3926
US

V. Phone/Fax

Practice location:
  • Phone: 910-671-9298
  • Fax: 910-671-4850
Mailing address:
  • Phone: 910-272-3048
  • Fax: 910-738-3764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD440134
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2012-02074
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: