Basic Information
Provider Information
NPI: 1922598572
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHAWLA
FirstName: MANOJ
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 856 J CLYDE MORRIS BLVD STE A
Address2:  
City: NEWPORT NEWS
State: VA
PostalCode: 236011318
CountryCode: US
TelephoneNumber: 7573165800
FaxNumber: 7575345190
Practice Location
Address1: 1000 OLD DENBIGH BLVD # 1020A
Address2:  
City: NEWPORT NEWS
State: VA
PostalCode: 23602
CountryCode: US
TelephoneNumber: 7578752009
FaxNumber: 7573691042
Other Information
ProviderEnumerationDate: 05/18/2018
LastUpdateDate: 07/16/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X0101266816VAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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