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General NPI Number Information
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NPI Number | 1407018229
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Entity Type | Organization
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Legal Business Name | CHANDLER & THAKUR MEDICAL GROUP
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 29 GLENDALE RD SUITE A
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City | UPPER DARBY
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State | PA
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Zip | 19082-2513
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Country | US
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Telephone | 610-352-3585
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Fax | 610-352-2979
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Provider Business Mailing Address
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Address Line | 29 GLENDALE RD SUITE A
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City | UPPER DARBY
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State | PA
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Zip | 19082-2513
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Country | US
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Telephone | 610-352-3585
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Fax | 610-352-2979
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. BRONELL CHANDLER
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Credential | M.D
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Telephone | 610-352-3585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD0481892
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License Number State | PA
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