MEDICARE: DR. RITU CHANDRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	26862	AL
2	208000000X	Pediatrics Physician	MD26862	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003890849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RITU CHANDRA MD

Provider Business Mailing Address
First Line	:	3700 S RAILROAD ST
Second Line	:	SUITE A
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-2993
Country	:	US
Telephone Number	:	334-664-0463
Fax Number	:	334-664-0466

Provider Business Practice Location Address
First Line	:	3700 S RAILROAD ST
Second Line	:	SUITE A
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-2993
Country	:	US
Telephone Number	:	334-664-0463
Fax Number	:	334-664-0466

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	09/25/2014

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Directions to “ DR. RITU CHANDRA MD” Practice Location

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