MEDICARE: SUMMIT ENDOCRINE & DIABETES PLLC

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	2011-00723	NC

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	:	1336520675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT ENDOCRINE & DIABETES PLLC

Provider Business Mailing Address
First Line	:	550 NEW WAVERLY PL
Second Line	:	SUITE 120
City	:	CARY
State	:	NC
Zip	:	27518-7412
Country	:	US
Telephone Number	:	919-642-3738
Fax Number	:	919-585-1554

Provider Business Practice Location Address
First Line	:	550 NEW WAVERLY PL
Second Line	:	SUITE 120
City	:	CARY
State	:	NC
Zip	:	27518-7412
Country	:	US
Telephone Number	:	919-642-3738
Fax Number	:	919-585-1554

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KHUSHBU ANIRUDHDHA CHANDARANA
Credential	:	M.D
Telephone Number	:	919-642-3738

Provider Enumeration Date	:	06/12/2015
Last Update Date	:	01/25/2016

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