Healthcare Provider Details

I. General information

NPI: 1336462670
Provider Name (Legal Business Name): ANKUR CHANDRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 652
ROCHESTER NY
14642-8410
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 652
ROCHESTER NY
14642-8410
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-6772
  • Fax: 585-756-7752
Mailing address:
  • Phone: 585-275-6772
  • Fax: 585-756-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA82410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: