Basic Information
| Provider Information | |||||||||
| NPI: | 1962677971 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADSHAW | ||||||||
| FirstName: | CHANDA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E PENN SQ | ||||||||
| Address2: | 9TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191073323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2674259234 | ||||||||
| FaxNumber: | 2674259299 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PLAINSBORO RD | ||||||||
| Address2: | CHOP CARE NETWORK AT PRINCETON MEDICAL CENTER | ||||||||
| City: | PLAINSBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085361913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098537000 | ||||||||
| FaxNumber: | 6094974173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2008 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MT192486 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 25MA028964400 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.