Basic Information
| Provider Information | |||||||||
| NPI: | 1659466225 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANGALMURTI | ||||||||
| FirstName: | CHAITANYA | ||||||||
| MiddleName: | SURENDRA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 E JEFFERSON ST | ||||||||
| Address2: | KAISER PERMANENTE MEDICARE ENROLLMENT | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208524908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018162424 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12255 FAIR LAKES PKWY | ||||||||
| Address2: | KAISER PERMANENTE FAIR OAKS MEDICAL CENTER | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220333952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039345700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD31721 | DC | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | D0066199 | MD | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | J4324 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 0101221322 | VA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.