Healthcare Provider Details

I. General information

NPI: 1508397449
Provider Name (Legal Business Name): ANJALI CHANDRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24801 PINEBROOK RD STE 202
CHANTILLY VA
20152-4113
US

IV. Provider business mailing address

PO BOX 37189
BALTIMORE MD
21297-3189
US

V. Phone/Fax

Practice location:
  • Phone: 703-722-2510
  • Fax: 703-722-2511
Mailing address:
  • Phone: 571-423-5699
  • Fax: 571-423-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101278783
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: