Healthcare Provider Details

I. General information

NPI: 1831109727
Provider Name (Legal Business Name): SANNASIE CHANDRASEKARAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SANN CHANDRA MD

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 LINDSEY LN SUITE 1
EXPORT PA
15632-2569
US

IV. Provider business mailing address

6420 LINDSEY LN
EXPORT PA
15632-2569
US

V. Phone/Fax

Practice location:
  • Phone: 724-689-8042
  • Fax: 412-321-2234
Mailing address:
  • Phone: 724-689-8042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD035100L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100013689
Identifier TypeOTHER
Identifier State
Identifier IssuerRRME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: