Provider Demographics
NPI:1871594572
Name:CHANDEL, ASHUTOSH (MD)
Entity type:Individual
Prefix:
First Name:ASHUTOSH
Middle Name:
Last Name:CHANDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1966
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-5966
Mailing Address - Country:US
Mailing Address - Phone:304-325-1915
Mailing Address - Fax:304-327-1795
Practice Address - Street 1:100 WESTWOOD COMMONS
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605
Practice Address - Country:US
Practice Address - Phone:276-326-1915
Practice Address - Fax:276-326-1917
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17527207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0076241000Medicaid
WV0749714Medicare PIN
F53194Medicare UPIN