MEDICARE: VISHAKA CHETRAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207RC0000X	Cardiovascular Disease Physician	83037	CT

General Provider Information

NPI Number	:	1134745375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VISHAKA CHETRAM

Provider Business Mailing Address
First Line	:	3300 GALLOWS RD
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031
Country	:	US
Telephone Number	:	703-776-4001
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 GALLOWS RD
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031
Country	:	US
Telephone Number	:	703-776-4001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2020
Last Update Date	:	05/20/2026

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Directions to “ VISHAKA CHETRAM ” Practice Location

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