Healthcare Provider Details

I. General information

NPI: 1790759348
Provider Name (Legal Business Name): CHICKY DADLANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 BEVERLY RD SECOND FLOOR
MCLEAN VA
22101-3603
US

IV. Provider business mailing address

1365 BEVERLY ROAD SECOND FLOOR
MCLEAN VA
22101-3603
US

V. Phone/Fax

Practice location:
  • Phone: 703-790-5850
  • Fax: 703-790-1028
Mailing address:
  • Phone: 703-790-5850
  • Fax: 703-790-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01001244894
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101244894
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: