Healthcare Provider Details

I. General information

NPI: 1366905366
Provider Name (Legal Business Name): CHAVA CHEZAR-AZERRAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8116 GOOD LUCK RD STE 305
LANHAM MD
20706-3508
US

IV. Provider business mailing address

325 CONGRESSIONAL LN
ROCKVILLE MD
20852-1505
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-1200
  • Fax:
Mailing address:
  • Phone: 240-893-3469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number115500
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: