Healthcare Provider Details

I. General information

NPI: 1811218456
Provider Name (Legal Business Name): CHANDRA SINGH JEYACHANDRA BERRY M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR NATIONWIDE CHILDRENS HOSPITAL
COLUMBUS OH
43205-2696
US

IV. Provider business mailing address

574 CARPENTER ST
COLUMBUS OH
43205-2629
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-6625
  • Fax: 614-722-6627
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number81-000097
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: