Provider Demographics
NPI:1285734228
Name:CHANDLER, PAUL T (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:T
Last Name:CHANDLER
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 1:9393 FIELDS ERTEL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-8211
Mailing Address - Country:US
Mailing Address - Phone:513-677-1919
Mailing Address - Fax:513-677-9379
Practice Address - Street 1:9393 FIELDS ERTEL RD
Practice Address - Street 2:SUITE A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-8211
Practice Address - Country:US
Practice Address - Phone:513-677-1919
Practice Address - Fax:513-677-9379
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039316207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0354110Medicaid
OHA77375Medicare UPIN
OH0441514Medicare ID - Type Unspecified