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General NPI Number Information
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NPI Number | 1548553068
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Entity Type | Organization
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Legal Business Name | PREM P. MANCHANDA MD, PC
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 4660 KENMORE AVE 220
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1313
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Country | US
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Telephone | 703-981-4865
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 ORCHARD DR
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City | FAIRFAX
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State | VA
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Zip | 22032-1021
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Country | US
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Telephone | 703-981-4865
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PREM MANCHANDA
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Credential | M.D.
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Telephone | 703-981-4865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101057630
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License Number State | VA
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