Basic Information
Provider Information | |||||||||
NPI: | 1073952081 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHANDLER | ||||||||
FirstName: | MARK | ||||||||
MiddleName: | ROBINSON | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 800 N JUSTICE ST # 16 | ||||||||
Address2: |   | ||||||||
City: | HENDERSONVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 287913410 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8286948350 | ||||||||
FaxNumber: | 8286947654 | ||||||||
Practice Location | |||||||||
Address1: | 800 N JUSTICE ST | ||||||||
Address2: |   | ||||||||
City: | HENDERSONVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 28791 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8286961000 | ||||||||
FaxNumber: | 8286961314 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/24/2013 | ||||||||
LastUpdateDate: | 08/04/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/04/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | ME126228 | FL | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 390200000X | TRN18880 | FL | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207P00000X | 2017-02300 | NC | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 19VDW | 01 | NC | BCBS NC | OTHER | NN0741A | 01 | NC | MEDICSARE | OTHER |