=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689670440
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAM I CHANDRA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2005
-----------------------------------------------------
Last Update Date | 12/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 OXFORD DRIVE SUITE LLB CHILDREN'S HOSPITAL OF PITTSBURGH OF UPMC
-----------------------------------------------------
City | BETHEL PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-692-3143
-----------------------------------------------------
Fax | 412-692-8848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1517 FOX CHASE LN
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15241-3147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-257-2040
-----------------------------------------------------
Fax | 412-257-5137
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0206X
-----------------------------------------------------
Taxonomy Name | Pediatric Gastroenterology Physician
-----------------------------------------------------
License Number | MD019008E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------