MEDICARE: CHANDRA A PRABHA MD

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	207ZD0900X	Dermatopathology (Pathology) Physician	38564	MA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	38564	MA

General Provider Information

NPI Number	:	1265534671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDRA A PRABHA MD

Provider Business Mailing Address
First Line	:	11117 PINION CT
Second Line	:
City	:	NORTH POTOMAC
State	:	MD
Zip	:	20878-2565
Country	:	US
Telephone Number	:	301-610-9283
Fax Number	:

Provider Business Practice Location Address
First Line	:	6825 16THST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20306-0001
Country	:	US
Telephone Number	:	202-782-2726
Fax Number	:	202-782-9182

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	09/11/2025

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