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General NPI Number Information
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NPI Number | 1790169308
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Entity Type | Individual
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Provider Name | DR. MANISHA K CHAWLA
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Gender | Female
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Dates
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Enumeration Date | 07/13/2015
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Last Update Date | 07/13/2015
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Provider Practice Location Address
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Address Line | 3460 OLD WASHINGTON RD SUITE 102
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City | WALDORF
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State | MD
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Zip | 20602-3240
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Country | US
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Telephone | 301-638-1420
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 S EADS ST APT 819
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City | ARLINGTON
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State | VA
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Zip | 22202-3027
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Country | US
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Telephone | 202-207-6677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 15989
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401414906
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN1001517
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License Number State | DC
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