=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366905366
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHAVA CHEZAR-AZERRAD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2019
-----------------------------------------------------
Last Update Date | 01/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8116 GOOD LUCK RD STE 305
-----------------------------------------------------
City | LANHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20706-3508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-552-1200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 CONGRESSIONAL LN
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-1505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-893-3469
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | 115500
-----------------------------------------------------
License Number State | ZZ
-----------------------------------------------------