Healthcare Provider Details

I. General information

NPI: 1477536415
Provider Name (Legal Business Name): RABIN CHANDRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BREWSTER ST DEPARTMENT OF FAMILY PRACTICE
PAWTUCKET RI
02860-4400
US

IV. Provider business mailing address

111 BREWSTER ST WOOD BLDG 516
PAWTUCKET RI
02860-4400
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-3469
  • Fax: 401-729-2541
Mailing address:
  • Phone: 401-729-3481
  • Fax: 401-729-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD10046
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: