Healthcare Provider Details

I. General information

NPI: 1699770388
Provider Name (Legal Business Name): RAJIV Y. CHANDAWARKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 TAYLOR AVE FL 1
COLUMBUS OH
43203
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8566
  • Fax: 614-293-3381
Mailing address:
  • Phone: 614-293-8566
  • Fax: 614-293-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35077896
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: