Provider Demographics
NPI:1588498729
Name:GOMES, CHANDAN PETER (MD)
Entity type:Individual
Prefix:
First Name:CHANDAN
Middle Name:PETER
Last Name:GOMES
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 1:6136 170TH ST APT M4
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1957
Mailing Address - Country:US
Mailing Address - Phone:301-919-7975
Mailing Address - Fax:
Practice Address - Street 1:1041 E 83RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4225
Practice Address - Country:US
Practice Address - Phone:718-709-0940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP128289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine