Healthcare Provider Details

I. General information

NPI: 1144210295
Provider Name (Legal Business Name): MRUNALINI A CHAKURKAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 06/06/2021
Certification Date: 06/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44055 RIVERSIDE PKWY SUITE 204
LANSDOWNE VA
20176-5179
US

IV. Provider business mailing address

8008 WESTPARK DR
MC LEAN VA
22102-3109
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-3333
  • Fax: 703-858-3330
Mailing address:
  • Phone: 703-287-1079
  • Fax: 703-287-1076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101232230
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: