Provider Demographics
NPI:1447623590
Name:CHANDAK, RAHUL B (MD)
Entity type:Individual
Prefix:
First Name:RAHUL
Middle Name:B
Last Name:CHANDAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAHUL
Other - Middle Name:BRIJBALLABH
Other - Last Name:CHANDAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:2670 CHANCELLOR DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5466
Practice Address - Country:US
Practice Address - Phone:859-957-0052
Practice Address - Fax:859-957-0054
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY585672084N0400X, 2084N0400X
MS278442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology