Healthcare Provider Details

I. General information

NPI: 1477178994
Provider Name (Legal Business Name): CHAITANYA D SAMBANGI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LINDEN AVE
BALTIMORE MD
21201-4622
US

IV. Provider business mailing address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 443-682-6800
  • Fax: 410-225-8395
Mailing address:
  • Phone: 410-328-5887
  • Fax: 410-706-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH0107111
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: