Healthcare Provider Details

I. General information

NPI: 1982797718
Provider Name (Legal Business Name): MAHESH CHANDRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9131 PISCATAWAY RD SUITE 710
CLINTON MD
20735
US

IV. Provider business mailing address

9131 PISCATAWAY RD SUITE 710
CLINTON MD
20735
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-8654
  • Fax: 301-856-7298
Mailing address:
  • Phone: 301-868-8654
  • Fax: 301-856-7298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberD0027902
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: