MEDICARE: PRATIMA CHANDLER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401417611	VA
2	1223G0001X	General Practice Dentistry	4613	WV
3	1223G0001X	General Practice Dentistry	17816	MD

General Provider Information

NPI Number	:	1528733326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRATIMA CHANDLER DDS

Provider Business Mailing Address
First Line	:	37 MADDEX DR
Second Line	:
City	:	SHEPHERDSTOWN
State	:	WV
Zip	:	25443-4322
Country	:	US
Telephone Number	:	304-876-2562
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 MADDEX DR
Second Line	:
City	:	SHEPHERDSTOWN
State	:	WV
Zip	:	25443-4322
Country	:	US
Telephone Number	:	304-876-2562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2021
Last Update Date	:	05/26/2026

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