Healthcare Provider Details

I. General information

NPI: 1265728489
Provider Name (Legal Business Name): CHANDNI PANKAJ KALARIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANDNI PANKAJ PATEL

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SUNDAY DR
RALEIGH NC
27607
US

IV. Provider business mailing address

1540 SUNDAY DR
RALEIGH NC
27607-6010
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-3456
  • Fax: 919-783-1441
Mailing address:
  • Phone: 919-782-3456
  • Fax: 919-783-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD044090
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2019-00969
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: