Southern Wellcare Medical PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

228243 Issued in NY

Legal business name

SOUTHERN WELLCARE MEDICAL PC

Practice address

2336 Grand Concourse
Bronx, NY 10458-6903

Phone

(718) 907-0195

NPI assigned

Jul 19, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Svetlana Khandros, D.O.

Title

President

Phone

(718) 220-0439

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571270400000",
    "number": "1396090932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2336 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104586903",
            "telephone_number": "718-220-0439",
            "fax_number": "718-933-2914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2336 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104586903",
            "telephone_number": "718-907-0195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN WELLCARE MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-19",
        "last_updated": "2019-10-17",
        "status": "A",
        "authorized_official_last_name": "KHANDROS",
        "authorized_official_first_name": "SVETLANA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-220-0439",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "228243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.