Basic Information
Provider Information
NPI: 1306038096
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHANDAVARKAR
FirstName: UMA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 255228
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 958655228
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2800 L ST STE 300
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 958165616
CountryCode: US
TelephoneNumber: 9164533300
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/15/2007
LastUpdateDate: 03/31/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/31/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VX0201X55322AZY Allopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology

No ID Information.


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