Healthcare Provider Details

I. General information

NPI: 1033212923
Provider Name (Legal Business Name): ALPANA CHANDRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 NW STEWART PARKWAY SUITE 103
ROSEBURG OR
97471-1516
US

IV. Provider business mailing address

PO BOX 1700
ROSEBURG OR
97470-0414
US

V. Phone/Fax

Practice location:
  • Phone: 541-672-9515
  • Fax: 541-464-3177
Mailing address:
  • Phone: 541-677-6111
  • Fax: 541-440-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036131695
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD28469
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036131695
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD28469
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036131695
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036131695
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: