MEDICARE: DR. VIJAYA LAKSHMI CHANDRAKANT 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	208000000X	Pediatrics Physician	141332	NY

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	:	1275516395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIJAYA LAKSHMI CHANDRAKANT MD

Provider Business Mailing Address
First Line	:	1468 RICHMOND AVE
Second Line	:	SUITE B
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1550
Country	:	US
Telephone Number	:	718-982-8922
Fax Number	:	718-982-9063

Provider Business Practice Location Address
First Line	:	1468 RICHMOND AVE
Second Line	:	SUITE B
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1550
Country	:	US
Telephone Number	:	718-982-8922
Fax Number	:	718-982-9063

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	12/02/2011

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