Provider Demographics
NPI:1285692244
Name:CHANDLER, KERRY EILEEN (MD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:EILEEN
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:EILEEN
Other - Last Name:WEINRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 19368
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-9368
Mailing Address - Country:US
Mailing Address - Phone:919-787-8221
Mailing Address - Fax:919-789-4461
Practice Address - Street 1:3949 BROWNING PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6504
Practice Address - Country:US
Practice Address - Phone:919-787-8221
Practice Address - Fax:919-789-4461
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-017552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC300071498OtherRAILROAD MEDICARE
NC79463OtherMEDCOST
NC1031JOtherBLUECROSS BLUESHIELD
NC891031JMedicaid
NC16-54688OtherUNITED HEALTHCARE
NC300071496OtherRAILROAD MEDICARE
NC16-54690OtherUNITED HEALTHCARE
NC300071497OtherRAILROAD MEDICARE
NC78137OtherMEDCOST
NC79461OtherMEDCOST
NC16-54689OtherUNITED HEALTHCARE
F91306Medicare UPIN