Healthcare Provider Details

I. General information

NPI: 1730187642
Provider Name (Legal Business Name): ANITA SHABNAM CHATMAN MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42010 VILLAGE CENTER PLZ SUITE # 100
STONE RIDGE VA
20105-3032
US

IV. Provider business mailing address

42010 VILLAGE CENTER PLZ SUITE # 100
STONE RIDGE VA
20105-3032
US

V. Phone/Fax

Practice location:
  • Phone: 703-542-7921
  • Fax: 703-542-7931
Mailing address:
  • Phone: 703-542-7921
  • Fax: 703-542-7931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101052287
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: