MEDICARE: KAILASH CHANDWANI M.D.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	MD440134	PA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	2012-02074	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	:	1912126244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILASH CHANDWANI M.D.

Provider Business Mailing Address
First Line	:	2002 N CEDAR ST STE B
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-3926
Country	:	US
Telephone Number	:	910-272-3048
Fax Number	:	910-738-3764

Provider Business Practice Location Address
First Line	:	4901 DAWN DR
Second Line	:	SUITE 3300
City	:	LUMBERTON
State	:	NC
Zip	:	28360-8287
Country	:	US
Telephone Number	:	910-671-9298
Fax Number	:	910-671-4850

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	11/02/2020

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Directions to “ KAILASH CHANDWANI M.D.” Practice Location

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