Basic Information
Provider Information
NPI: 1043219710
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHANDA
FirstName: SANDHYA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 17334
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212971334
CountryCode: US
TelephoneNumber: 7034436717
FaxNumber: 7034438643
Practice Location
Address1: 19450 DEERFIELD AVE
Address2: SUITE 400
City: LEESBURG
State: VA
PostalCode: 201766820
CountryCode: US
TelephoneNumber: 5712235723
FaxNumber: 5712091848
Other Information
ProviderEnumerationDate: 07/15/2005
LastUpdateDate: 03/07/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X0101232028VAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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